Mongolia's liver cancer crisis: 'No other country has a problem like this' www.theguardian.com

Danzan Purev beams as he shows members of a support group photos of his infant nephew on his iPhone. The 68-year-old geologist is charismatic and jokes with the others gathered in the room in Ulan Bator. But his mood changes as he begins to recount his long experience with hepatitis, a disease that has blighted his life.

Purev was diagnosed with hepatitis B and C in the early 1990s. By the end of the decade his health and quality of life had deteriorated, leaving him constantly sick and fatigued. He had to sell his business to finance a trip to Korea to undergo treatment, which was not successful. “Financially, I just went down,” he says.

Once back in Mongolia, he was unable to afford hepatitis drugs, and began to lose hope as the disease continued to affect his liver. “I was really scared,” says Purev. “My dad and all the relatives on my dad’s side died of liver cancer and liver disease. I didn’t want to be one of them. I just wanted to keep fighting and cure myself.”

Fortunately, he heard about the non-profit Onom Foundation, which offers screening and treatment for hepatitis. Today he is cured of hepatitis C, has low levels of hepatitis B, and the health of his liver, which at one point was two-thirds non-functional, has improved.

Purev has been lucky. According to the World Health Organization, Mongolia has the world’s highest rate of liver cancer, as well as the highest mortality rate from the disease. Each year, liver cancer and liver cirrhosis account for 15% of all deaths. Chronic hepatitis is the most common risk factor in developing liver cancer, and 400,000 of Mongolia’s 3 million citizens are diagnosed with a hepatitis virus.

The National Cancer Centre, which this year will begin performing liver transplants. Photograph: Hannah Griffin
The WHO says hepatitis cases spiked in Mongolia in the 1970s and 80s, when syringes were regularly reused and dental and surgical practices were not always hygienic. Additionally, the country has high rates of “hepatitis B and D super-infection”, which occurs when someone with chronic hepatitis B becomes infected with hepatitis D.

“There is no other country in the world that has a problem like this,” says Dr Naranbaatar Dashdorj, co-founder of the Onom foundation, which runs group therapy sessions for those like Purev living with hepatitis in Mongolia’s capital, as well as providing hepatitis screening and treatment to thousands of people.

But the government is waking up to the health crisis, pouring significant money into screening and treatment in an attempt to reduce cases of liver cancer. By 2020, ministers want to eliminate hepatitis C and significantly reduce liver cancer and cirrhosis deaths.

Last year, parliament ploughed 23.4bn Mongolian tugrik (£7m) into the country’s health insurance scheme to subsidise hepatitis medicine. This year, the government allocated MNT 226bn for screening and treatment until 2020. This money also covers free hepatitis testing for those between the ages of 40 and 60, who make up the bulk of liver cancer patients. This will be extended to a younger cohort in 2018.

This cash injection will reduce patient costs drastically. After subsidies, patients pay between $3 (£2.25) and $13 (£9.70) for hepatitis B medicine, and between $65 and $215 for hepatitis C medicine. Before subsidies were introduced, medicines could cost thousands of dollars.

“In the area of treatment Mongolia is making really good progress in screening the people, identifying people with chronic hepatitis,” says Narantuya Jadambaa, a technical officer in Mongolia for the WHO. “But we need more work also to stop the transmission within the whole society. It would require more efforts and even more financial support as well.”

The National Cancer Centre, a busy hospital where Mongolians from all over the country come for diagnosis and treatment, performs 450 liver surgeries a year. This year, it will start performing liver transplants. Dr Chinburen Jigjidsuren, the centre’s general director, says in the past two years approximately 160 Mongolians have travelled overseas for transplants. He hopes more people will now stay in-country for surgery. About 70 people are on the government waiting list for a liver transplant.

Dr N Yumchinserchin, head of the intervention radiology department at Mongolia’s National Cancer Centre
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Dr N Yumchinserchin, head of the intervention radiology department at Mongolia’s National Cancer Centre, explains that their angiographic equipment is outdated. If the equipment fails, it would be difficult to find spare parts to repair it. Photograph: Hannah Griffin
But a major factor in reducing liver cancer deaths is early diagnosis. Many Mongolians are not diagnosed until they are late-stage and inoperable. Jigjidsuren says many people travel from their rural homes to the capital only to be told there is little that can be done. He hopes the centre can establish a system to connect provincial health centres by internet so patients can have online consultations with doctors prior to coming to the city. “We are trying to avoid this problem and trying to establish a good system,” he says. “I hope that Mongolia will be an example to the world [on] how we fight liver cancer.”

Myamjav Jargalsaikhan, 63, is another member of the Onom foundation’s support group. He was diagnosed with hepatitis C and liver cirrhosis 30 years ago, and had been receiving treatment each year. In 2013, after retiring from a 40-year career as a technical engineer at a printing company in Ulan Bator, he was diagnosed with liver cancer. Just as he was ready to enjoy a more carefree life after years of hard work, he was sidelined.

“Any plans I had made for the future just all stopped,” he says. But unlike many other patients, Jargalsaikhan’s liver cancer was operable, and he has been cancer-free for three years. Despite all the challenges, he considers himself fortunate. “I really consider myself lucky to have had the disease for so many years and survived it.”

Centerra Gold to buy AuRico Metals in Cdn$310 million friendly deal www.mining.com

Canada's Centerra Gold (TSX:CG) took a fresh step towards strengthening its position in the home market by signing a deal to acquire smaller rival AuRico Metals (TSX:AMI), in a friendly transaction valued at Cdn$310 million ($243 million).

Beware of bitcoin bubble, warn investment & financial advisors, as it smashes $7,600 www.rt.com

Bitcoin's sevenfold rally is one of the telltale signs of a bubble, according to investment strategists. It started the year at $973 and rocketed to $7,600 on Sunday, up over 750 percent in 10 months.

AngloGold cash flow, output jump in third quarter www.mining.com

South African AngloGold Ashanti (JSE:ANG) (NYSE:AU), the world’s third-biggest producer of the precious metal, said Monday it saw cash flow and production jump in the three months to September 30.

Mitsubishi and other trading houses raise full-year forecasts www.asia.nikkei.com

TOKYO -- Japan's seven major trading houses have reported their half-year results through September.

Overall, the outcomes -- all announced by Monday -- were encouraging, thanks mainly to a recovery in resource prices. More than half the companies raised their full-year forecasts, with some even deciding to increase shareholder dividends.  
Mitsubishi Corp. on Monday revised up its forecast for full-year group net profit through March 2018 by 50 billion yen to 500 billion yen ($4.39 billion). That would mark a 14% increase on the previous year and exceed the trading house's all-time high of 471 billion yen posted during the year through March 2008 -- a time when the global economy was buoyed by the rise of emerging countries.

Sumitomo Corp., Itochu and Toyota Tsusho also expect to log record-high profits for fiscal 2017. Sumitomo has raised its net profit projection now to 280 billion yen. 

Mitsui & Co., on the other hand, is unlikely to renew the record profit posted for the year through March 2008. It will, however, at least see its highest earnings since adopting international accounting standards in the year ended March 2013.

Soaring resource prices have been the biggest contributing factor behind the strong performances. Prices of coking coal used in steel production have risen around 80% from the average during the first half of the previous year. Copper and iron ore prices have followed suit.

Car sales, construction machinery leasing, food and food products are also performing well at all the trading houses, largely supported by a strong global economy, especially in Asia.

By sector, Mitsubishi's metal business, which includes coking coal, will likely see a 32% increase in profits to 195 billion yen, while earnings at its machinery division, which includes car sales, are expected to almost triple to 75 billion yen.

"The boom in resource prices tends to be highlighted, but this is the result of consistent efforts to enhance other [machinery and food] businesses," said Kazuyuki Masu, chief financial officer at Mitsubishi, during a briefing on Monday.

Some trading houses are looking to use the extra cash from the enhanced profit forecasts to increase dividends to shareholders. Mitsubishi, Sumitomo and Toyota have raised their payouts for this fiscal year. Itochu and Mitsui have so far kept the amount unchanged, but will likely either increase dividends or launch a buyback scheme during this fiscal year.

The leading trading houses appear to be generally expecting the positive outlook to continue for the time being. "Resource prices could drop within a short space of time, but over the long term, they will return to an upward trend," said Mitsui's CFO Keigo Matsubara.

Koichi Takahata, Sumitomo CFO, is also optimistic about the near-future forecast for resource prices. "For the next 12 months or so, we will not see sharp ups and downs," he said.

Geopolitical risks could pose one of the few uncertainties for the rest of the fiscal year. Results could depend on whether the trading houses are able to rebalance portfolios to secure new revenue sources while the business environment remains favorable.

Government to fight against illegal acts related to special licenses www.montsame.mn

Ulaanbaatar /MONTSAME/ Prime Minister U.Khurelsukh stated that the Government will fight vigorously against illegal trading of land ownership and mining licenses, during his speech to the Parliament last Friday in connection with a discussion of 2018 State Budget Bill.

‘Steppe Gold’ files for IPO www.news.mn

Toronto-based Steppe Gold is a precious metals exploration and development company focussing on opportunities in Mongolia. The company has filed a preliminary prospectus in connection with a proposed initial public offering (IPO) of its common shares.

Greenhouse farming technology to be introduced in Mongolia www.montsame.mn

Ulaanbaatar /MONTSAME/ “Mongolia has a lot to study experiences from Greece; in particular the country is interested in naturalizing Greece solutions of greenhouse farming technology that are fit to Mongolia’s climatic conditions,” said B. Batzorig, Minister of Food, Agriculture and Light Industry, during the November 3 meeting with the Non-Resident Ambassador of the Hellenic Republic.

Affordable housing prototype in Mongolia’s suburbs www.domusweb.it

Designed by Rural Urban Framework, Ger Plug-In is a traditional Mongolian building, a portable structure made of timber, felt and canvas. It is located on the edge of Bayankhoshur, one of Ulaanbaatar’s ger districts – sprawling settlements comprised of a mixture of gers and low-cost detached homes. It is estimated that over 700,000 people live in the ger districts, accounting for over 60% of the city’s population. The numbers are constantly growing with new migrants moving from the countryside to the city daily. It is likely the only city in the world where the poorest people own the majority of the land. The city has expensive new development plans to bring services and apartments to the residents of the ger districts. However, they do not reach the fringe areas where Zulaa and Urangua live. The project tackles the problem from the basic unit of habitation – the one thing that all residents own – the ger itself.

Water Quality in Mongolia: Better Infrastructure Needed www.borgenproject.org

Bordering Russia and China, Mongolia, the landlocked country in northeast Asia, has been experiencing more severe and frequent effects of climate change. Among several of these issues, water quality and scarcity are at the top of the list. Mongolia’s unique landscape is comprised of sparse rivers, lakes and springs that flow from the wooded northeast, leaving most of the east and south with a desert climate.