Andrew Cullen
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Over Before It Starts

April 25, 2010 @ 12:02 AM | Permalink

Bayan Ulgii is Mongolia's western-most province, set in the Altai mountains where Mongolia, China, and Russia converge. It is also the only province where Mongolians are not the majority: About 90 percent of the population is ethnically Kazakh.

The Islamic Kazakh community has a higher birthrate than their Mongolian neighbors, as well as one of the highest maternal mortality rates in the country. In 2008, Bayan Ulgii's MMR was 76.7 deaths per 100,000 live births, compared to the national average of 49 per 100,000 live births. And while infant mortality hovers near the national average, Mongolia as a whole has the 67th worst infant mortality rate in the world, according to the CIA's 2009 estimate. 

On a recent visit to Ulgii, I tried to learn more about the beginnings of life and premature death there. 

In the central hospital's maternity ward, I saw Soviet made equipment, decades old, waiting to be replaced. The hospital- the main source of intensive health care for the roughly 100,000 people in the province-  generally sees a handful of births a day. The ward has only a few doctors and a handful of nurses on staff. 

Although none of the women I talked to at the hospital complained about the care they received, I heard rumors from a number of people around town that the doctors of Bayan Ulgii do not always act professionally. Some blamed the low government salary doctors receive (currently the national doctors' union, alongside the teachers' and railroad workers' unions, are in negotiations with the government and threatening to strike if their salaries aren't doubled). Some said that the doctors may be drunk on the job; others told me that bribes, including gifts of vodka, were necessary to secure the best care. 

The bribes aren't necessarily solicited. "To be more safe, they will give money, then the doctor will check carefully," one nurse's husband, the couple themselves the parents of a healthy infant, told me. 

Such rumors are unsubstantiated. The director of one INGO's regional health project said, "It's difficult, we can't catch them. I haven't seen them taking money,  so I can't say that they are. But I can say they are, because people are saying it." 

Bayan Ulgii's head pediatrician, Khuatkhan, says that the hospital didn't have all the essential resources it needed until october of 2009, when an $11,000 World Vision grant allowed them to purchase new equipment. The hospital's facilities remain less than desirable. "The children that died this year"- 19 in January and February alone- "had treatable conditions, if the hospital had sufficient funds, equipment, and medicine," he says.

Medical facilities aside, the families of Bayan Ulgii face another obstacle to fighting infant and maternal mortality: poverty. Forty percent of the population is very poor, according to Khuatkhan. Severe malnutrition is common among the children treated in Bayan Ulgii's hospital, as is anemia, which afflicts forty percent of mothers in the province.

Three months old, the boy has gained just 300 grams- less than a pound- since his birth. A health baby gains about 900 grams a month. He lives with his parents, both unemployed, in a one room mud plaster house. They own just five goats, and since the government suspended a program which provided families with a small monthly payment for each child a few months ago, survival has been a struggle. Local doctors who normally make house calls refuse to give the baby check-ups at home, saying it is too cold there; while it continues to snow sporadically, the family has run out of heating fuel.  

Maternal and infant mortality rates have dropped significantly in Bayan Ulgii during the last decade, as they have globally, although progress is not a given: more of Bayan Ulgii's mothers died during childbirth in 2009 than in 2008. Neither Bayan Ulgii's hospital nor its economy seem likely to improve significantly in the near future. In the meantime, its people will carry on as they always have. Says the regional INGO health director, "I would say that Bayan Ulgii is very hardworking. That is the only reason they're surviving."   

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