Clinical Professor Hugh Parsons, an ophthalmologist who first came to Mongolia as a tourist in 2014, noticed that the skills and availability of local ophthalmologists in our country were not good enough. Therefore, since then, he has come to Mongolia 14 times to train our doctors, including local ophthalmologists. We talked to Canadian Professor Hugh Parsons of the University of British Columbia, Project Leader of the Laurel Surgical Foundation, about his work in Mongolia, eye diseases, and prevention.
“WE CALCULATED TO BE 1750 PATIENTS WE'VE OPERATED IN MONGOLIA”
- Thank you for having the interview with us in your busy schedule. First of all, we are really appreciating your favor to Mongolians to reduce and prevent eye deceases. How did you connect with the Mongolia?
- In 2014 I came to Mongolia as a tourist. When traveling in Mongolia two things made me very excited. Number one, I immediately fell in love with Mongolia. The people and the beauty of the countryside. As a Canadian, the wide open spaces and vast distances made it felt like home.
But, when I was traveling through the country side I was curious about the medical needs of Mongolians in the remote regions. Having over 30 years of experience of in overseas medical projects I wondered if there was a need for our medical teams to help.
After returning to Canada, I started to research and inquire about Mongolia’s medical system. It turns out that one of my Canadian medical colleagues had medical contacts through the Church of latter Day Saints. I spoke with him, I was put in touch with Mongolian health care teams and came to Mongolia in 2015 for a survey visit. The local medical people told about the challenges they faced in providing care. Yes, there was a way in which the Laurel Surgical Foundation could help.
We want to treat as many patients as we can, but we want to spend the proper amount of time teaching the ophthalmologists.
The most important role, we thought, would be training eye care specialist (ophthalmologists) so that when returning to the provinces they would have the skills to (such as cataract surgery) to treat patients closer to home for the patients.
- How many Mongolian people that have you examined?
- Yes, we have a rough estimate. So, we have had 14 medical trips. I knew that the great distances, the geography and the harsh environment created challenges for many patients in the provinces to travel to UB to receive care. We know that many patients were not receiving care as they could not afford the travel to go to UB to obtain the eye care that they needed.
When I visit Mongolia, we (the Laurel Surgical Foundation )come as a medical team that can have anywhere from 10 to 20 individuals in that team. When we visit, we examine many patients here in UB, and then we'll go to the remote provinces and see and treat patients as well. So, the surgeries we typically do approximately 150 per visit. So, if I look at these ten visits where I've done a lot of patients, we're looking at almost 1000 or more patients that we've operated on. We calculated to be 1750 patients we've operated on. So, if I look at these fourteen visits we have performed over 1800 surgeries (mostly cataract) and examined and treated over 20,000 patients during our time. Each time we come in, it seems to get bigger and bigger, but we're ready for that.
- Does your team do examinations and surgical in provinces?
- We work with our Mongolian colleagues and we each perform approximately 50% of the patients visits and 50% of the surgeries. Before we arrive, the Mongolian doctors will have looked at number of patients and we will see them. But we see them in a 50, 50 and we're teaching the whole time. So, if I'm looking at a patient and trying to figure out what to do, the resident, the trainee will be with us. So, we shared that experience. If we're doing surgery, the trainee will be with us learning how to do the surgery. So, we want to treat as many patients as we can, but we want to spend the proper amount of time teaching the ophthalmologists.
- This year marks the 50th anniversary of the establishment of diplomatic relations between Canada and Mongolia. As a valuable contributor to the relationship between the two countries, please share your thought.
- Yes. When the Canadian ambassador to Mongolia, Catherine Ivkoff, had indicated to me that this was the 50th year. There's a lot of similarities between Mongolia and Canada and Mongolians and Canadians. First of all, the climate is one. Ulaanbaatar is the coldest capital in the world. Ottawa, our capital, is probably number two. We get snow, but in our climate we can get much more snow. We have very remote areas. So, most of Canada, over 90%, as in Mongolia are large open spaces. In our north, the Artic, there are forests and large open spaces. It can be forest fields and the Arctic part of Canada eliminate so the big open air, the expanse. As well, I found that Mongolians enjoy the outdoors, and so do we. You can see that we have very much in common.
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Success means that we will not have to take teams on outreach clinics anymore as the local eye doctors will provide all the care that the patients need. We feel this will take maybe 8-10 years to achieve that goal.
I was impressed that we had 50 years of diplomatic relations with Mongolia, but not surprised that we have had such an enduring and close relationship. When I first came here, you could feel the connection, and I'm certain the ambassadors and the Mongolian Canadian representatives feel that connection as well.
- What is the main work of the Laurel Surgical Foundation?
- It’s all about education. Every team member is a very experienced teacher. We have the skills necessary for teaching the students, the residents. But we're also very experienced in teaching the teachers. So, you can be a teacher, but you need to learn how to teach. If you're giving lectures, you might think you’re doing a very good job, but you're not. So, you need to learn how to do that. If you're teaching surgery, it's very difficult to learn how to teach surgery. You must be very good, very confident and very calm. And We’re sharing those skills with the teachers will then be teaching the student eye doctors.
Laurel Surgical Foundation team members have the experience to help develop the training program for the eye doctors. They have set up a curriculum (a guide for training)as well as training to perform surgery. We have also set up a lab where the doctors can practice surgery.
At the end the graduates will be able to provide services such as cataract surgery and treat many other eye problems. Most patients will no longer have to travel to UB for care. Education, training, is how to provide access to care for all Mongolians.
- By the way, how many provinces have you traveled around Mongolia? I assumed most of them, right?
- Yes the teams have been to seven provinces. What we do is, when we go to a province, we examine many patients, we operate on the patients, but we don't need to go every year. An example would be. The team will go to a province such as Govi Altai, examine patients and perform surgeries. The next year we will travel to another province, such as Arkhanghai and other provinces until we are needed again in Govi Altai.
In the meantime, we'll go to these other provinces. We can't reach every province in terms of treatment, there are groups that will be able to reach those provinces.
Our goal is that the Mongolian doctors have the training so that when they return to their provinces they can look after almost all the eye problems themselves. One of the most common causes reversible blindness is cataracts (clouding of the lens) and these surgeries will be done in the provinces.
Success means that we will not have to take teams on outreach clinics anymore as the local eye doctors will provide all the care that the patients need. We feel this will take maybe 8-10 years to achieve that goal.
- You mentioned that Mongolian ophthalmologists’ skill. So, comparing with the first time you have visited in Mongolia, how was the doctor's skill and technology, how much differences in examination equipment technology and skills that we have improved now?
- Very much. When we first came the foundations for eye care were very strong of The department of ophthalmology at the First Central Hospital. This department has been present for over 60 years, so they have a strong reputation of training doctors. The unfortunate part is that many of those doctors, when they finished their training, they couldn’t do surgery. The ones here that operate it were very, very skilled. But not very many of them, when they graduate, were able to do that surgery. So, the provinces weren't able to take advantage of that.
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The doctors when returning to the provinces will be able to screen for diabetic damage to the eyes and treat locally or when best to send to UB.
One of the doctors here, Dr. Enkhtuul, one of the outstanding surgeons at the First Central Hospital was invited to come to Canada for two years of specialized training. When returning to Mongolia Dr Enkhtuul was first surgeon at the First Central Hospital to provide care surgical care for patients such as diabetics and many other problems that occur in the back of the eye.
Like you asked the training program is missing some very critical equipment. And we eventually set up a plan where we can improve each of those areas. So, the first area was improving the surgical training for the doctors. The Church of Latter Day Saints donated a microscope that is critical to the training of eye surgeons. The next step was to improve how they can evaluate and treat patients such as diabetics. We bought so far two pieces of equipment, and the third one is on its way to help evaluate those type of patients. The advantage to that is significant.
Number one, the patient prior used to have to go to the private sector to get their care. Now to get those studies done, the diagnosis now they can get it done in the hospital, and they don't have to pay anything for that. But also, the doctors in training and learning from these latest pieces of equipment. They're learning about diabetes. An example is the management of diabetes when it damages the eye. Diabetes is a rapidly growing problem in Mongolia and can result in blindness. Early diagnosis and treatment of diabetic eye disease can often prevent blindness. The doctors when returning to the provinces will be able to screen for diabetic damage to the eyes and treat locally or when best to send to UB.
- And what kind of eye diseases, mostly among people, especially children in Mongolia?
- So first of all, in the adult population, the most common cause of blindness is cataracts. But you can fix that. And that's why we're doing surgical training. Coming up very quickly, it would be diabetes and high blood pressure. The diabetic rate is very, very high in Mongolia. 25 years ago only 4% of Mongolians were diabetics, now it is estimated that 14% are. By comparison, in North America, 8-10% are diabetic.
We anticipate a wave of problems coming towards us that people start to lose vision from diabetes. So that's a very serious one that we’re encountering more and more frequently. About the children, our program has just recently been focusing on the Children’s Hospital. Children in the countryside often have sore and burning eyes. As they get older these problems can cause vision loss much earlier in life. It’s from the environment, it can be from air pollution, but it can also be from sand and sun exposure that starts doing damage early. So by the time they're in their 20s, they look like somebody maybe should be in their 50s before they get that problem.
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When asked to assist in other countries the answer is no. We are 100% dedicated to working with our Mongolian colleagues to improve access to care.
The other problem is that some children have would be what we call lazy eyes, where their eyes may be crossed or not straight. That one is a repairable one. This is correctable and the doctors at the Children’s hospital are already experts at managing such problems. The other ones that they encounter are much less frequent, but very serious. And if you have a baby that's born too small, born too early, sometimes their eyes can get very damaged. And they're very skilled now at screening or looking at those babies and catching the problem and treating it early. And that prevents blindness. If those little children go blind, are from the age of one or less than one year of age. They can be blind. But now, with their programs set up, they can prevent most of that from developing.
- So, if the woman gave a birth before the baby due, they should examine the baby's eye first, right?
- Yes. So, there's an age where we know that the baby’s at very good high risk of developing it. So, if the baby is born at 36 weeks the baby’s eye will likely be okay. However those babies born before 36 weeks may have eyes that have not had a chance to fully develop. These babies are screened by the doctors at the Children’s Hospital. The eye doctors are skilled at detecting and treating these premature babies eyes. These babies are then examined on a regular basis until the eye doctors feel there won’t be any further problems.
- Do you work active such as like Mongolian in another countries?
- I don't. I have worked in many different countries, pretty much in Asia, but if you name an Asian country, I probably have worked there. Since the laurel Surgical Foundation started in Mongolia in 2015 the team focuses only on Mongolia and developing its eye training programs through education.
When asked to assist in other countries the answer is no. We are 100% dedicated to working with our Mongolian colleagues to improve access to care.
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If you're diabetic, you need to have your eyes examined every year at least. If you have high blood pressure, you need to have them examined every year at least.
- As an ophthalmologist, please give us some simple advice for people how to prevent eyes, especially for children.
- So for children, if the parents concerned about whether the eyes are straight or not, they can often tell. Parents are very good at telling whether the child is struggling with, maybe for reading or maybe for seeing far away. The parents are very good at determining whether that's a problem. So, if the baby's still young and the eyes are straight, they seem to be behaving properly, then they're probably okay. They won't need an examination until a little bit older, but usually somewhere in around the four to five age group. But of course, if they're struggling and they would want an examination early on. The irritated eyes in a child, there’s not a lot you can do about that. You can't change the environment. The parents might be aware of keeping the eyes clean, helping the child with maybe some comfort, cool face cloths, but usually it's just not worthwhile seeing an ophthalmologist for that.
In the adult population, then they too should probably have regular screening. If you're in the countryside, a lot of these adults are very exposed to the wind and the sun, and we try and encourage them to wear eye protection. So, a simple pair of sunglasses with ultraviolet UV protection will help prevent a lot of problems, will help prevent cataracts and cornea burning sore eyes. It's difficult though, but when we go, we often will distribute many sunglasses. If they're driving, riding a horse, or riding motorcycle, it's even worse coming at them. If you're diabetic, you need to have your eyes examined every year at least. If you have high blood pressure, you need to have them examined every year at least.
If you have any other health problems, such as kidney disease or liver disease, you need to have your eyes examined regularly. If you're healthy, you probably need a basic exam once, and then the doctors say, okay, we’ll see you when you have a problem. But somebody with high blood pressure, diabetes, may not know they have an eye problem, so they need to be examined before they start to lose the vision. And with ophthalmologists and eye disease, it's all about early detection treatment. You want to treat them before they lose vision.
“MEETING MANY PEOPLE HAS MADE MONGOLIA ONE OF MY FAVOURITE COUNTRIES”
- During the time when you are in Mongolia, what was your most unforgettable experience or Mongolian person?
- First time I came here, and that has never changed has been the areas outside of Ulaanbaatar. I've been from the Gobi Desert in the south. I’ve been all the way up to Selenge Province, to the Russian border. Each area is beautiful. I have had to opportunity to experience living and eating in gers. Enjoying the company and food of the herders families. We have even stayed in a herders cabin in northern Mongolia. Mongolians are a strong and proud. A country is great because of its people. Meeting many people has made Mongolia one of my favourite countries.
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Sharing adventures with our Mongolian friends creates memories that will last forever.
Traveling has given me the opportunity to develop strong friendships. Even though the person, the Mongolian may not speak English and I don't speak Mongolian. Tsegi was one of the first Mongolians that I met. We became friends. Tsegi was so keen to show me Mongolia. We didn’t need a translator as we experienced many exciting adventures together.
One of our adventures was traveling in northern Mongolia. We were going out for a long hike. Before setting off we needed food. Our Mongolian hosts picked out a sheep, slaughtered it and the sheep provided most of our food for the next week. With a simple stove they were able to cook and prepare everything for us. And then I found Mongolians are very hearty. The weather, the cold, whatever, doesn't seem to bother them like it would bother a lot of people. So, all that I enjoy very much. Mongolians are very strong. Neither the weather of the environment seems to bother them at all. Sharing adventures with our Mongolian friends creates memories that will last forever.
- Is there anything you want to tell us that I didn't ask?
- I would like to share with you that we have a very long-term relationship with our Mongolian colleagues. Our work is 100% dedicated to Mongolia. Education leads to a sustainable eye care program which will eventually improve access to care for all Mongolian. We have a close relationship with our colleagues here. There’s never been any arguments or confusion. We work as one.
The Ministry of Health and the center for health development are very supportive. Their support is critical to developing and implementing the program. All of us work together in partnership to improve eye care for all Mongolians.
- Thank you so much. Good luck to you and your team.
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