AMDA transfers endoscopy techniques to Mongolian National
University of Medical Sciences (MNUMS)
Prof. Takushi Sato
(AMDA Board Member, Professor at the Faculty of Allied Health Sciences, University ofEast Asia)

Introduction:
Marking its third time, this year’s endoscopy
training at Mongolian National University of HealthSciences (MNUMS) was something to remindourselves of the drastic change currently taking
place in the Mongolian medical sector. One
significant event to note is the establishment ofMongolia-Japan Teaching Hospital scheduled toopen in June 2019. With the financial backing ofthe Japanese government, the new facility is
expected to offer high-level medical training andmedical services.

This year’s training was held from 29 April to 2
May 2019 at MNUMS, a forerunner medical
institution in the nation. As facility relocation wasunderway to move the endoscopy room into thenew teaching hospital, this became the final
training to be held at the old building. During thisperiod, about 70 patients had their upper andlower abdomen examined. In addition, 16 trainee
doctors were able to gain hands-on experience byusing a colonoscopy simulator brought in fromJapan.

Mongolia-Japan Teaching Hospital
opening in mid-June 2019

Simulating colonoscopy

After the training ended on the 2nd of May, MNUMS started the preparation work to movethe endoscopy room into the new hospital on the following day.

According to 2016 statistics provided by WHO and Mongolian Ministry of Health, thecommon causes of death in Mongolia are, 1) heart disease and stroke, 2) cancer, and
3) accidental death. Referring to 2), although the types of cancer slightly vary between
men and women, 78% of the cases are usually detected at stage 3 or 4 regardless ofsex. Likewise, 85% of them die within a year from detection. In response to this criticalsituation, Mongolian Ministry of Health set a goal to reduce the number of cardiovasculardiseases and cancer by 2030.

Common Types of Cancer in Mongolia
MenWomen

1
LiverLiver

2
StomachStomach3
Lung
Cervical4
Oesophagus
Oesophagus

Why medical technology transfer is needed:
1) For early detection, diagnosis and treatment of cancer
2) To hopefully reduce medical expense incurred by patients and the government3) To foster young doctors (to make a good use of medical equipment donated fromJapan and help the doctors acquire high-level skills)

AMDA Endoscopy Training 2019 overview:
Upon instructing the trainees, Prof. Davaadorj. D (President, Mongolian
Gastroenterology Association) and Prof. Oyuntsetseg (Director of Endoscopy Unit,MNUMS) offered their kind support.

I told the trainees that as long as doctors conduct endoscopy, they must shoulder anenormous amount of responsibility and should not overlook the subtle changes that may
occur in the early stage of ailments. I also reiterated it is important to minimize the burden
on patients when carrying out endoscopy.

Standing side by side, I repeatedly told the young doctors to look harder and give aprecise diagnosis while demonstrating the practical techniques. The cases we saw werereflux oesophagitis, atrophic gastritis, H. pylori infection, superficial gastritis, gastricpolyp, gastric erosion (upper abdomen), as well as ulcerative colitis, ischemic colitis,colon polyp, diverticulosis, and haemorrhoid (lower abdomen). There were some casesof biopsy, however, no malignant case was found.

I was fortunate enough to talk directly with theaspiring youths who are studying under Prof.
Davaadorj. D. Expressing my high hopes, I advised
the trainees to become a doctor who can transcendcountry borders and cooperate with the likemindedothers around the globe in the near future. I also
added that we must be responsible for the very lifethat exists in front of us and continue to make efforts
on a daily basis to attain the skills that save lives.

Colonoscopy simulator:
For all the doctors and trainees, it was their first time to have a go at the colonoscopy
simulator. One of them was a doctor who has been in charge of infant endoscopy at thehospital’s maternal and infant health centre from this year. A skilled young doctor whohad already handled over 4,000 cases of endoscopy also joined the session.

The initial goal, which was set to allow the beginners (five of them) to insert the scope
up to appendix, was achieved fairly well. For experienced doctors, they used the device
to simulate more complex cases such as sigmoid volvulus. The workshop continued until
the closing time of the hospital. When Dr. Badrakh demonstrated the skills he acquiredin Japan last year, it proved that the expertise had been passed on to Mongolian doctors
with certainty.

Everyone trying out the simulator

Prof. Sato instructing Dr. Badrakh whocame back from Japan

Mongolia-Japan Teaching Hospital:
Scheduled to open in June 2019, Mongolia-Japan Teaching Hospital embodies the stateof-the-art architecture Japan has to offer. When I paid a visit to the new hospital’s
endoscopy unit on the 30th of April, cutting-edge devices had already been installed. Iwas asked through which route a patient should be transferred to reach the endoscopy
room in case of emergency. I also gave tips on infection prevention after using theendoscope. It is expected that the level of practical endoscopy environment in Mongolia
will reach the Japanese standard in the next few years.

Conclusion:
Highlighting the enhanced skills among Mongolia’s next generation of doctors, Prof.
Davaadorj. D and Prof. Oyuntsetseg thanked AMDA for the last three years of medical
technology transfer. They expressed their hope for the continuation of this project asthere are a range of specialties such as emergency endoscopy, EMR, ESD, ERCP andballoon endoscopies that are yet to be covered.

On a side note, MNUMS will be sending another doctor, Dr. Enkh-Amar Ayush, for his
training at Saiseikai Hospital in Okayama, Japan from September to November 2019. As
always, I am greatly looking forward to accepting enthusiastic doctors from the overseas.

Message from Prof. Davaadorj. D (President, Mongolian Gastroenterology Association)“It is our third time to receive Prof. Sato’s guidance, andevery single workshop has been an important opportunity
to let our young doctors learn essential skills such as
emergency endoscopy, ESD and colonoscopy. I would
like to extend my sincere gratitude to Prof. Sato andAMDA for their tireless contributions.”
Prof. Davaadorj D. and Prof. Sato

Comments from endoscopy patients“After I received colonoscopy last year, a local Mongolian doctor told me to come backagain this year. This time, I was relieved to learn that the result was fine. I will make it apoint to get a check-up annually.” Mr. Zoljargal (a male patient in his 30s)

“I was worried as there was something wrong with my abdomen after having rectal
bleeding. I came to find out that no inflammation was detected in my stomach and thatput me at ease.” Mr. Khabul (a male patient in his 30s)

“I had endoscopy for the first time after feeling pain in my stomach. Not knowing what
the treatment was, Prof. Sato kindly explained to me the symptoms and cure in detail.”
Mr. Boldbaatar (a male patient in his 50s)

“Something didn’t feel right in my throat for a while, but I
didn’t know what it was and had to leave it as it was.
Thanks to endoscopy, I finally had it checkedthoroughly.” Ms. Unenbat (a female patient in her 50s)