Our First Encounter with Healthcare in Mongolia

The jeep rolls up the hill, and the doctor emerges, with a metal box of tricks. She’s a slight, friendly woman in her 30s: I like her immediately.

“Painkilling injection!” Zac yells. I second this in pidgin Mongolian.

“She needs to examine him first,” says Bill.

“She can’t give you a shot until she’s seen how you’re doing,” I backtrack, faced with reason.

The doctor’s case does not include shears, so I cut Zac’s thermal off him, while Maahar puts the final touches to his newly whittled sticks, rather in the manner of a tricoteuse knitting by a guillotine.

Pulse, heart, pupil response – all good. Now to the arm itself.

There is no way of examining a broken arm on a hilltop in the middle of Outer Mongolia without causing pain. The doctor’s gentle palpitations of the enormous bump that marks Zac’s fracture have him wincing; her tender manipulation of his shoulder leaves him crying out in pain.

She looks up at me, her face grave. “Mörön?” I ask.

“Mörön,” she confirms. Of all the places to experiment with healthcare in Mongolia, Mörön would not be my first choice.

The doctor’s box of tricks does not extend to a sling. We improvise one from the remains of Zac’s thermal and a scarf I have in the backpack.

In pidgin Mongolian, assisted by the phrasebook, I insist on a painkilling shot before splinting, remind her of Zac’s weight, and seamlessly, the doctor, Maahar, I and the lovely lady from the cabin, whose name – so sadly – I still don’t know, move into position.

Zac’s eyes are wide with panic. I grab his good hand supportively, put my other hand on his chest to restrict his movement, and get him to count in Chinese, by way of distraction.

“Let’s start,” I say. “I’ll do odds, you go evens. Yi.”

“Er.”

“San.”

“Si….”

Maahar and the lady from the cabin follow the doctor’s instructions. The doctor layers bandages around Zac’s broken arm, Maahar places his whittled sticks carefully in position while the lady from the cabin supports the arm, and then the doctor wraps another round of gauze over the top.

By the time she’s done, working as fast and as painlessly as she can, Zac and I are beyond 180 in Chinese. And still no tears.

The doctor’s box of tricks does not extend to a sling, either. We improvise one from the remains of Zac’s thermal and a scarf I have in the backpack, and roll towels up to keep the upper arm away from his torso.

I clamber in beside Zac, and position my body as a wedge, left leg up against his right thigh, right leg braced under the seat in front…

Maahar rummages through my medical kit. “Is this what you’re looking for?” I ask, producing the Cipro that I’d tried to force on him for his stomach, the night he drank the horse shit juice. He shows it to the doctor. She nods.

And then… We’re good to go. We say our farewells to the guys we’ve ridden with so long, on our journey to the reindeer people.

The chaps help Zac into the back of the jeep. Baatar, still muttering, “I’m sorry, T,” loads our backpacks into the boot. The doctor hops back in beside the driver.

I clamber in beside Zac, and position my body as a wedge, left leg up against his right thigh, right leg braced under the seat in front, left hand on the handle above the window, right arm braced against the ceiling.

It’s over an hour to the clinic in Tsagaannuur, over open country, including river beds. The driver eases slowly off the clutch, and he’s clearly going to go as gently as he can, but still….

… There are no roads. And so this is going to be brutal.

“Yeah, fine,” he says, eyelids lolling, head relaxed. “Really?!” I exclaim. “Yeah,” he says. “Actually, I think I might be tripping.”

I notice, though, as we judder down a rocky gully that must be a rushing torrent during the snow-melt season, and my ceiling arm begins to ache from holding the two of us in position, that Zac isn’t even wincing.

“Are you alright?” I ask.

He looks, in fact, like he’s on ketamine, or, as we 90s ravers said back in the day, some “very smacky pills”.

“Yeah, fine,” he says, eyelids lolling, head relaxed.

“Really?!” I exclaim.

“Yeah,” he says. “Actually, I think I might be tripping.”

God only knows what the doctor’s given him – I’m guessing Tramadol – but it lasts him all the way over valleys, gullies, rocky river banks and rattling pontoon bridges, through the grassy streets of Tsagaannuur and up to her lakeside clinic.

Result!

Cervico-spinal damage? Head injuries? Cardiac arrest? A catastrophic bleed? I don’t even want to think about how those would play out out here.

As an introduction to healthcare in Mongolia, the clinic in Tsagaannuur is, in some ways, better than I’d expected: a low, single-storey building set right by the lake, with an epic woodpile for heating that reaches almost to the roof.

This rural Mongolian clinic has electricity, which is great, and – better – 24/7 electricity at that. The pit toilets boast both roofs and lockable doors. And — be still, my beating heart! — they’re clean.

It does not, however, have running water, although there are little dispensers above the sinks that distribute lake water in hand-washing quantities. On the equipment front, it is equally limited.

All in all, though, it’s rather better than I’d have expected from a clinic in a tiny Mongolian town, serving so small and scattered a population. Which doesn’t mean I’m not in a hurry to get my child out of here.

Cervico-spinal damage? Head injury? Cardiac arrest? A catastrophic bleed? I don’t even want to think about how those would play out out in Tsagaannuur.

Zac goes on one of the children’s wards, a room with two beds with brightly coloured duvets. A massive iron stove serves both this room and the one next door: two perky pre-kindergarteners peek through the holes around it to inspect the foreigners.

The first act on arrival? A new splint.

Oh Jesus.

We are several hours drive from uncle Google, so I look up the word for “tight” in the phrasebook, head to the office, and wave the phrasebook at the doctor.

Using the phrasebook, I ask for more painkillers. Zac can’t have any yet. Not for another hour.

For this splint, a layer of cotton wool topped by a contraption of what look like lollipop sticks linked together with thread, and completed with a wrapping layer of elasticated gauze, I have Zac count in powers of two, and, once we get up towards the five figure mark, in powers of three.

Distraction works a treat.

Soon after splinting, though, Zac’s hand begins to twitch. “My muscles are spasming, Mum,” he says. “It really hurts.”

We are several hours drive from uncle Google, so I look up the word for “tight” in the phrasebook, head to the office, and wave the phrasebook at the doctor. She checks the splint with a finger. It’s fine, she indicates. He needs to clench and unclench his fist from time to time.

The girl in the shop believes that a guy in the big house with the red roof – that one! Over there! – might have an internet connection I can use to track down my insurance details. I buy more credit for my Mongolian phone.

I head to the shop, the same one we visited last time, in those halcyon days when all was well, and stock up with Goe drinks, Riesen, water, straws and easy nibbles (pickled mushrooms, pickled cucumbers, raisins, apples, buns).

The girl in the shop believes that the guy in the big house with the red roof – that one! Over there! – might have an internet connection I can use to track down my travel insurance details.

Back at the hospital, we divvy up our treats between the little kids in the ward next door, the nurses who stop by to keep us company, and the doctors.

It’s rather social, actually. Every time someone new pops by to see how Zac’s doing, we hand round nibbles. It feels positively, well, Mongolian.

The house that might have internet is a posh house, with two storeys, an attic, and a flashy brass plate that, by Mongolian standards, pretty much shouts “I can afford internet, y’all!”. It is also firmly closed.

Zac needs some drugs. So the doctor writes a prescription, and a nurse escorts me to the pharmacy, a room in someone’s cabin a bit further down the lake, for an exotic selection of painkillers and (mystifyingly) antibiotics to add to the selection in our medical kit.

Back on the children’s ward, we learn that clinic facilities don’t extend to bedpans, so they equip me with a bucket. By about 7, Zac’s anaesthetised to the hilt, relaxed in bed, Riesen positioned within easy reach of his working arm and Goe with straw installed in sipping reach, and I can head out on a mission to find our travel insurance details.

The house that might have internet is a posh house, with two storeys, an attic, and a flashy brass plate that, by rural Mongolian standards, pretty much shouts: “I can afford internet, y’all!” It is also firmly shut.

Staring at its locked, corrugated iron gates, and debating whether there’s any point in climbing over them or whether I’ll just get savaged by dogs, I feel, for once in my life, a very, very long way from civilisation. I decide to park the travel insurance for the moment, and get onto Mongolia’s answer to the Milk Tray Man, this Doctor Shirley with her personal helicopter.

“We only have three beds in our emergency room. We don’t have complex surgical facilities and there is NOWHERE in Mongolia that can do that operation safely, if it’s a bad break that needs a plate, or anything that requires paediatric general anaesthesia.”

Doctor Shirley is, it emerges, the clinic manager at SOS Medica Mongolia, the only international-standard medical facility in all of Mongolia, a super-calm South African who deals with horse-riding injuries and worse all the time from the clinic in Ulaanbaatar.

“Where are you?” she asks.

“In Tsagaannuur, Khovsgol province. It’s about 12 hours drive from Mörön, up near the Russian border,” I say.

“We can’t get a helicopter to you tonight,” she says. “I’m sorry. It’s a long flight from UB, it’s almost sunset now, and the pilots can’t fly after sundown. If we can get everything in place with your insurance tonight, I can have them take off in the morning, and they’ll be with you in the middle of the day tomorrow.”

I get the doctor’s mobile number; a Mongolian member of SOS Medica’s staff calls her to confirm both that Zac requires medevac and that he’s well enough to be evaced safely (“fit to fly”).

The helicopter company calls. They want GPS coordinates. My guidebook has a GPS reference for Tsagaannuur, and the contact guy at the chopper firm gets a visual description from the doctor.

Meanwhile, the clinic staff have kindly found a local resident who speaks some English to establish whether or not we need the land “ambulance” to Mörön in the morning. “I don’t know,” I say. “I’m hoping for a helicopter, but I need to arrange that with people in England.”

Her English, like the phrasebook, does not extend to “helicopter”. I do a helicopter impersonation, and then a drawing.

“You do realise,” Shirley explains to me, on perhaps our third call of the evening. “That we can fix a straightforward break, but if he needs surgery he’s going to need to be evaced out of the country? We only have three beds in our emergency room. We don’t have complex surgical facilities and there is NOWHERE in Mongolia that can do that operation safely, if it’s a bad break that needs a plate, or anything that requires paediatric general anaesthesia.”

Even within the village hospital telephony is so bad that people are swapping mobile numbers around depending on who has most credit. But there’s going to be a way around that too. There has to be. Everything is doable.

Farcically, I still don’t have our insurers’ number. Shirley can’t find the emergency contact number on their site, only the office number, whose working hours are 8.30am to 5.30pm, UK time: it’s the middle of the night there now.

I give her my Gmail address and password, but Shirley doesn’t use Gmail. She’s an MS Office person and I’m a Mac webmail person, and I can’t talk her through the search function on Gmail when I haven’t seen a Gmail screen for more than two blissful, blissful weeks.

I ring Ganbaa. He is still out of town, and his wife still can’t find the piece of paper with our insurance details on it, and in any case, I’m not entirely sure the phone number’s on there, although I know our policy number is.

I call Shirley back to say I’ll call her back. There HAS to be a way around this.

Even once I find the number, of course, I have no idea how to call it, since my SIM’s not set up for international calls, this isn’t the size of town that has a post office with international phone services, it’s evening, and even within the village hospital telephony is so bad that people are swapping mobile numbers around depending on who has most credit.

But there’s going to be a way around that too. There has to be. Everything is doable.

I rarely feel patriotic (I’m British so, when not moaning about the weather, I bitch and whine like nobody’s business), but, my lord, these guys make me proud we once had an empire and retain the sang froid to match.

Enter the British Embassy, like the seventh cavalry (thank you, Ganbaa!). I’ll spend a lot of time on the phone to the British Embassy’s Consular Assistance Out of Hours Service over the next few days, and I can’t recommend them highly enough.

I rarely feel patriotic (I’m British so, when not moaning about the weather, I bitch and whine like nobody’s business), but, my lord, these guys make me proud we once had an empire and retain the sang froid to match.

“Hi,” I say. “I’m in Mongolia, my son’s got a broken arm, we’re in a rural clinic in the middle of nowhere, we need to arrange a helicopter evac, and I can’t find the number for my insurers’ emergency line because there’s no internet for miles. Would you mind having a look on their website for me? I think it’s somewhere in the section under policies. You kind of have to go deep into the site and fiddle around a bit: it might be near the policy wordings? Or even actually in the PDFs?…”

“Give me a second,” says the guy, completely calmly. There is audible clicking and tapping in the background. “No, that’s their office number. Nope. Office number again. Wait… Bear with me… Bear with me… Got it! It’s OneAssist. I’ll give you the number to write down, but would you like me to connect you once that’s done?”

“Yes, please,” I say, holding back an inner whoop of joy. International calling – problem solved!

Like I say, I love the British Embassy. Free international telephony for muppets who didn’t write vital phone numbers down even when embarked on something manifestly dangerous, and not a jot of judgement there at all.

“So, you say you’re in a medical facility at the moment. Is there any reason why you can’t stay there?” “Yes,” I say. “It doesn’t have running water, my son has a broken arm, the nearest X-ray is 12 hours away and there aren’t any roads.”

I go through my spiel, which is by now on its fifth iteration, and so fluent, verging on polished. “Do you have your policy number?” the girl asks.

“No, not yet,” I say. “But I have an extremely unusual name, my son’s name is uncommon, and I can pretty much guarantee we’re the only people with those names and dates of birth travelling on one insurance policy on the planet…”

“I’ll need a policy number to process your claim. We don’t hold personal details on our system.”

“BUT….” I begin, sputtering.

“That doesn’t mean I can’t start things moving now,” she says, adding in a ‘computer says no’ voice, “I didn’t say I can’t help you now.” I bite back my natural instinct to start a battle about semantics, and stay very, very quiet. “So, you say you’re in a medical facility at the moment. Is there any reason why you can’t stay there?”

“Yes,” I say. “It doesn’t have running water, my son has a broken arm, the nearest X-ray is 12 hours away and there aren’t any roads.”

A small, stunned pause echoes down the line. “So… It’s kind of basic, is that what you’re saying?”

“Yes,” I say. “It’s a small rural clinic in a developing country with the lowest population density in the world. IT. HAS. NO. RUNNING. WATER. THERE. ARE. NO. ROADS.”

I explain that SOS Medica is getting an evacuation plan in place, and that this involves a helicopter. This is clearly above her pay grade. Someone will call me back.

The kicker: “Are you registered with a UK GP?” “God,” I say. “I’m not sure we are! Is that in the fine print?” It is. Oh fuck. I had, I believe, read every single element of the fine print of our insurance…

Sally, duly, calls me back. She’s a Gmail user, thank god, and another person I’ll spend a lot of time dealing with over the next few days.

We need our insurance details to get things moving, so I give Sally my email login details, and talk her through searching my email until we find the policy document. With that in place, just a few token questions to confirm that we’re eligible for cover. Was it an organised tour? Was he wearing a helmet?

And then the kicker: “Are you registered with a UK GP?”

“God,” I say. “I’m not sure we are! Is that in the small print?”

It is. Oh fuck.

I had, I believe, read every single element of the fine print of our travel insurance, particularly fine-toothing the residency requirements given we’ve been out of the UK for over three years. I’d duly bought extra cover for our trip to Everest Base Camp, extra cover whenever we went skiing, notified them of Zac’s surgery ahead of time and accepted that complications wouldn’t be covered, etc. etc. – but I had missed that one little bit. That one, little, super-critical bit.

Oh…. Fuck….

Do we want the machina to Mörön? I shrug. I make the sign for “helicopter”, then a big expressive “I don’t know” shrug, then cross my fingers. I have no idea if this sign language makes sense, and frankly, I’m past caring.

It gets hairy.

I bandy around terms like “misselling”, itemise various email exchanges, make a remarkably polished case for us being “ordinarily resident” in the UK, and ring poor Ganbaa to request photographs of our EHIC cards via email to Sally, who, as a fundamentally nice person, is basically on our side.

Sally needs to talk to the underwriters. She will ring me back.

If we’re not covered, that means we’ll be on the land ambulance to Mörön in the morning on our own dime, and my (mercifully) sleeping child is now at the mercy of the Mongolian public healthcare system, because, lord knows, I can’t afford a chopper out of here, and I very much doubt I can afford more than a couple of days in SOS Medica, at that.

The doctor sticks her head around the door. Do we want the machina to Mörön? I make the sign for “helicopter”, then a big expressive “I don’t know” shrug, then cross my fingers. I have no idea if this makes sense, and frankly, I’m past caring.

Finally, Sally rings me back. “Our underwriters have confirmed that they’re prepared to extend cover to you ex gratia. That doesn’t mean they’re going to go after you for their money back, but it IS ex gratia cover rather than an acceptance that you are covered under the policy terms, and I need to inform you of that. I’ll get back to you with more details on the evacuation later.”

“Can we make that before midnight?” I ask. It’s been a long and stressful day, and I’m starting to flag.

I call Shirley and hand over all the insurance details: policy number, assistance reference number, Sally’s phone number, the works. My notebook, by now, is a scrawl of random digits. If she can get a plan with budget in place, the helicopter guys can get clearance for their flight plan, and Sally can get everything signed off by the insurers, the helicopter can take off in the morning. It’s a four and a half hour flight.

“So,” I say. “Are we good to fly tomorrow?” “Our medical team are exploring all the options,” she says. “WHAT options?” I hiss psychotically. (Sorry, Sally!)

On the dot of midnight, god bless her, Sally rings with an update. “So,” I say. “Are we good to fly tomorrow?”

“Our medical team are exploring all the options,” she says.

“WHAT options?” I hiss psychotically. (Sorry, Sally!)

The reason, for what it’s worth, that one gets travel insurance is precisely so that one gets choppered out of these situations rather than travelling on a meat wagon with no suspension for twelve hours over riverbeds to a hospital in a place like Mörön.

“Well,” she says. “It’s a long flight to Ulaanbaatar…”

“Where else are we going to go?!” I ask. “Novosibirsk?! Arkhangelsk?!”

“Yeah, you really are in the middle of nowhere, aren’t you?” she says, sympathetically. “Do you have Russian visas?”

“No,” I say. “No Russian visas, no Chinese visas. Oh, wait… So it will be a helicopter?”

“Yes,” Sally says, in the calming tones of one whose job consists of managing people in various combinations of hysteria, trauma, injury, bereavement, anxiety, confusion, frustration and rage. “You’ll be leaving tomorrow, and it will be on an aircraft. We’re not sure where to yet, but we’ll update you in the morning, and it will definitely be on an aircraft.”

I look at Zac, sleeping like a baby under his duvet. I’ve got as far as I can get with this tonight.

Further, it’s 1am, we’re around 13 hours out from injury, it’s been an extremely tiring day and I could, frankly, do with some sleep.

This is why you need travel insurance. You can get a quote here.

Picture credit: The Sticks by StarMama.