Mongolia, Mongolia, Mongolia... so much to share!

6/22/09

Mongolia, Mongolia, Mongolia…so much to share

I am sorry for the delay in posting. I have been working very hard and having a lot of fun. First I will follow up on a question left open on my last post; when the Russians ran the place did they paint things? I once again asked my co-worker and told her I was serious. She said that the Russians painted about once every 10 years. I have never been in the Soviet Union, so I do not know if it has always been unkempt and run down or if that is a result of the fall of communism. If you know please let me know.

This Friday and Saturday I am delivering another training on grant writing and project planning. Once again, I am thankful I have both studied and taught this material. Training here is an adventure because of the translation and me not having a sense of what they already know. For the second time, please wish me well.

My supervising professor, Gautam Yadama arrives here in UB on Saturday and stays until Wednesday. He has worked here a lot, is the contact for Washington University for the Open Society Institute; a George Soros Foundation project, and has taught summer school here for social workers. It will be great to have him here and I am sure I will learn a lot. He is brilliant, driven, over committed and really supportive of students and me. I never quite know what to expect, but it is always interesting.

I think I mentioned earlier that we are working on a proposal to increase access to health services for disadvantaged groups in the ger districts here in UB. This proposal is for work to support a project in place funded by the Japan Poverty Reduction Fund channeled through the Asian Development Bank. Our work will be to do a situation analysis, household survey, and institutional assessment to develop a very clear picture of what is really happening for poor people in the ger districts related to health. Next, we will develop criteria for starting pilot projects to improve access to health services, and then monitor and evaluate these projects.

Mongolia and many countries around the world are trying to switch their health focus from a treatment model to more of a prevention, wellness, and primary care model. The primary care model is the preference of the World Health Organization and is being “pushed-supported” in many developing countries. Here it is a really good idea, but it is very different from the hospital based health care system utilized before. So the hurdles for effective implementation are large including the need to change cultural expectations and health behaviors and patterns.

Last week we went to visit a Family Group Practice (FGP) – primary health clinic in one of the targeted ger districts, the pink house in the pictures. I know I missed the meeting details due to the language barrier, but my co-workers filled me in. This FGP does a fabulous job with what they have to work with, but the same as my information on treating victims of sexual abuse there is not the money or infrastructure to do what they really want to do. They do not have adequate equipment and what they do have it is because this group solicits organizations for equipment, support, etc. Apparently this is not the norm. But even though I could not understand the meeting discussion I did learn a lot, just by observation.

I have walked through ger districts between my house and the largest monastery in the city – more on that to come in another post. But I have not really had the opportunity to grasp the details or lay of the land for those who live there. This visit gave me a much better sense of it all.

The ger districts surround the city, and last I checked over 49% of the population lives in these districts. They are made up of areas with wood houses and a fenced in area. Within the fenced area are gers, sometimes several. People who have more money have built houses, and then they allow relatives to put gers up in their yard, or they rent the space to others. I want to make it very clear that these districts are huge and they surround the city. None of these houses or gers have running water or toilets in the houses, and the government is not planning to change this. The government is building more wells in the districts, but all residents have to haul their water. And remember UB is incredibly dirty, even in the parts of the city with buildings. All the roads in the ger districts are dirt.

When I inquired why the government is not working to bring water to these houses and gers, I was told that they want to do away with all of these districts and replace them with apartments. I was stunned. As my co-worker Chimge said this will never happen. This is a culture built on nomadic pastoralism. People don’t like cities, they want space and they have a lot of stuff in their yards. How that will ever work for these people to live in apartments is truly a question that should be asked. Also, last semester I did a large research project on Urban Development and the research shows that the most cost-effective and best way to implement urban development is through urban upgrading – providing infrastructure in place where the people already live. Not only does this cost so much less than moving people, building new apartments, and then re-locating them; but also across the board if infrastructure is built and people are given secure tenure rights then they invest on average 2 to 4 times what was spent on the development. The people living in the ger districts want to be close to the city for employment and they definitely like having more space. So, the expansion will continue and the lack of sanitation and basic necessities will continue.

Inside the FGP we visited, there are small wall altars to Buddha and the Mongolian doctors practice a combination of traditional and allopathic medicine, which is great. They do have sinks with running water in each room, and the place is very clean. There is limited equipment and certainly not what we would call “advanced” equipment. There are no toilet facilities in the building. The toilet is out back in the fenced dirt yard in a locked outhouse. The outhouse has a big pit with wood planks above it and there is space between two of the planks. In Mongolia, there usually is not toilet paper provided so you bring your own, and even if there is a toilet you do not put the paper into it. It is amazing the level of commitment and caring these doctors have and how hard they work even with so little.

I read a recent report that talked about how poverty levels in the ger districts are rising. Counting all of Mongolia the average household monthly income is 344,700 togrogs, roughly about $243.60. The average monthly household expenditure is about 355,700 togrogs, roughly $251.38. And this is not dealing with just the ger districts. Ulaanbaatar’s poverty level this year is 57.5%. It is amazing to me that a country that once was doing very well, has been ravaged by both Chinese rule and then Russian rule. And yet, I remind myself that India and many of the African countries have been working at development since they gained independence from colonial rule varying between 1940’s and 1960’s. Mongolia has only been independent since the early 1990’s, was left in an economically devastated state and is slowly working to rebuild. It is a very interesting, fascinating and challenging place and I really like it. Except for missing my wonderful husband tremendously along with my family and friends, I am thriving here. I will update more frequently because I have lots of stories and info to share. But for now, it is to bed! Thank you for reading and for your ongoing interest and support!