Mongolian Medicine

On the Steppes of Genghis
 

· Expedition Medicine,Remote Health Care

It’s 343 am and the cold is biting through the lower part of my sleeping bag, however, I sit up and fumble with my head torch. I can hear Dan calling from a tent nearby. I unzip my sleeping bag and throw on my unlaced boots before breaking the warm seal on the tent and making the short journey. As the designated team medic on an expedition crossing part of the Mongolian Steppe on horseback, I am often called upon for all manner of issues.

 As I approach his green tent, he is still zipped inside, and I make my presence known by calling back to him. As I unzip the lower part of the outer shell of his tent Dans foot appears, then both feet. Confused, I continue unzipping and Dan continues to slide out silently. Without a word spoken yet, I make eye contact with the offending spider on the inside of his tent. It has a massive fat body and obvious small fangs and as I catch Dans eye, we both laugh. The joy of expeditionary leadership curtails everything from getting a team safely from point A to point B to unzipping a tent to escape a giant, yet somewhat harmless spider.

For centuries the nomadic communities have followed the migration patterns across the Mongolian Steppe and it remains one of the final frontiers on earth. 

Whilst exploring the isolated plans it is easy to consider that this remains one of the least populated counties on Earth. Where Genghis Khan and his kin once rode, crossed and conquered. It is easy to get lost physically and found spiritually. 

The Expedition

The expedition team of 12 were from varying professional educational backgrounds. They had planned a route that would take them into western Mongolia to support a remote kindergarten and I had been contracted to safe keep the team. 

The most effectual way for our team to reach our expedition’s staging point in Khatgal in Eastern Mongolia was by car (well sort of). It was by a Forgon (an off-road four-wheel drive van) and we needed two of them. We hired two Mongolian brothers Una and Boltun. Although they only possessed about 20 English words between them, their infectious and animated attempts to assist us in communicating provided entertainment on both sides. From Ulan Batar, it was a three-day drive across the steppe, with wild camping along the way to reach the expedition staging area in Khatgal. Just prior to departure the brothers called into what is locallyknown as the “black market”.  A place teeming with both locals and authorities. The team had planned to purchase a large pot and a large pan, however, after considering careful advice from the brothers, the team walked away with two large pots, two large pans, utensils, and enough second-hand water containers for about 80 litres. Spare petrol was stored on the roof and back door, and people, pots, pans and luggage were stored anywhere in between. The wild camping was pleasing, and the starry night skies were phenomenal to the point we were almost disappointed arriving  in Khatgal. The brothers bid us  farewell with a cheeky wave and one of our large pans!

From there a family of wranglers (a father and his four sons) were hired to supply horses and to guide our team on the impending journey across the steppe. A total of 22 horses were required to carry people, supplies and wranglers. When we negotiated an agreed price Father Jimmy, the lead wrangler, advised our team to also purchase three sheep and 5 chickens. These would evidently be used as fresh meat during the journey as well as used to barter for yaks’ milk and cheese once isolated on the steppe with the nomadic communities. 

Riding across the steppe – who needs medicine in heaven?

Riding through open fields of wildflowers across the vast steppe gives you an impression of riding in heaven. The locals say that traveling Mongolia without a horse is like being a bird without wings and I got it. We would ride, we would rest, wewould eat, we would sleep, and all around the warmth of an open fire. Talk about travelling like Hemingway. 

Riding and falling…..”mmmmeedic”!

Mongolian horses are wild hearts, they are not kept in paddocks but roam free on the vast Mongolian steppe. It’s a peaceful place of indescribable beauty and soul, that is, right up until the moment it’s  not. Without warning, Ben’s horse made a shriek, or Ben shrieked, I was not sure, but Bens horse  bucked violently and bolted. It was evident that he had no chance of regaining control. The horse kicked wildly and tripped which sent Ben airborne. He cartwheeled over the horse’s head and into an embankment on a small creek. As I manoeuvred Chunky (my horse) near Ben I saw two of the wrangler children in hot pursuit of the wayward team meber. Ben was lying on his back groaning. He had sustained a few bruises but fortunately, no obvious or catastrophic injuries. After a small rest, he mounted a pony to be led by one of the wranglers for a few hours. Serial check-ups occurred for the next few hours, but it seemed we had by chance, avoided catastrophe.  

An eye for an eye…..”mmmmmmeedic”!!

The end of daily routine involved selecting a camp site that was close to a water source and protected by the wind. Also, near a firewood supply if possible. Although wild, the Mongolian horses are also incredibly well trained. The horses were untacked and set relatively free free to graze, tents were erected, and fire collection and water collection teams moved out.    While I was airing my feet, Binari the youngest of the wrangler brothers came into camp bleeding from just under the eye. He had been out collecting firewood when he had accidently gauged himself. I was about to retrieve the medical kit when his father swabbed the inured area with the waxy fat from one of the cooked sheep, slapped him on the back of the head gently and sent him to get more wood.

This is a place where nomadic communities continue to roam.   The famed Mongolian horsemen continue to apply their trade, and you can really hear the wind between a horse’s ears. However,   it is also a place of distance and remoteness, where health issues and injuries can rapidly amplify due to the lack of proximity to infrastructure. However, this is specifically what attracts people to journey over, through and between the highlands of the Mongolian Steppe.

A crash in the forest and a bee hive of gold…….”mmmmmmmmedic”!

Mongolians share a rich and traditional culture with their horses dating back thousands of years. People say that the wind you hear between the horse’s ears is akin to the sounds of heaven and whilst our horses trot most of the day, we share the occasional gallop. Although concerned for the welfare of the team, a good daily gallop is part of the Mongolian experience.  The gallop came to an end as we entered a forest. The momentary bliss of the silent forest was again broken, this time by the shriek of a horse and a crashing sound. The impending dull thud of a human body impacting the ground came with sickening precision. However, I noticed the sash on the bolting horse indicated it was a wrangler’s horse, Sula’s to be exact. It was his horse bolting riderless through the forest and back across the steppe. Sula was a tall strong lad. The oldest of the brothers, he was 17 and would be leaving to university next year. He was already on his feet and waving wildly. I watched in awe struck amazement as one of his younger brothers galloped over and lifted his brother onto the back, barely breaking a stride, and then both proceeded after the irritable horse. So even the wranglers can get thrown from their horses. 

When the brothers returned to the group, there was a heated discussion and a small pouch was retrieved from the pack mule. They proceeded to lather the petulant horse in wax like substance and then Sula removed his deel (traditional Mongolian jacket) and his brother began covering him.

He had several red marks on his body and needed to sit down. The youngest of the brothers quickly explained with excitement that Sula’s horse had accidently disturbed a beehive in the forest. I went to check on Sula who had a concentration of stings on his neck and face. He gladly accepted the offered stingless spray and then some antihistamine and paracetamol. 

Father Jimmy was already instructing two of the brothers to don extra clothing to prevent more stings. On the steppe, a  hive of bees is considered    a pot of gold, albeit a risky one. I monitored Sula for a few hours while his pain decreased and swelling abated and we were all soon back onward bound through the forest to find    a camp site. 

Rights of passage

For nearly two weeks I ate nothing but sheep, potato and spring onion. Across  the wild plains of the Mongolian steppe in summer is an abundance   of wild spring onion. Each day the team would collect handfuls in preparation for dinner. Then in the evening the wrangler boys would produce sheep stew, bone broth, sheep dumplings, or my favourite - sheep on a stick. They also bartered with the nomadic families for yak’s cheese for snacks and yak’s milk for tea.

One such night the team were privileged to witness the coming of age of Binari. He was turning ten and was required to select, kill and butcher one of the sheep for the next few days of supplies. With the assistance of his brothers the task was completed.  The hide was dried the   next day and was traded with a nomad family who had a new born baby. The baby was immediately wrapped in it for warmth. The meat was stored for  use over the next few days. 

The Ger in the storm

During an afternoon it became apparent that a storm was going to catch our team in the open. Father Jimmy rode ahead into the valley and as the wind whipped up a   freezing rain storm, we lost sight of him. The brothers brought our team into a small gaggle of trotting horses to ensure   no one was lost but  visibility was extremely limited. Out here mother nature can turn quickly,   but hospitality reigns strong. Nomadic families live together and support each other. Sometimes a ger community can house 4 generations and in the harsh winters, it’s a great way of limiting fuel usage. Father Jimmy returned with news that he had located a family who were willing to shelter us. The ger was less than 8 meters across and already housed 6 people. They slept where they cooked and lived very simple but harsh lives. The immediate warmth when entering the ger from the subzero storm was a relief to everyone. We crammed in as best we could, and the host family offered milk tea and yak’s cheese. Whilst the storm raged outside, the team huddled together trading souvenirs and showing pictures to the family. I utilised this time to conduct a quick health survey of the team and apart from some very minor ailments, most were in almost flawless condition. 

Onwards the journey goes

It is fascinating how your worst experience can result in your best stories. Although the storm was initially a big risk to our team, it resulted in an amazing shared cultural experience bunking down with a nomadic family.

The next morning, I left the ger whilst the others slept in and assisted the brothers in rounding up the horses. Simula called me to one particular horse who had somehow received some serious wounds during the storm. The mare had a large 26-centimetre laceration on her right leg and some small lacerations on her face. The boys had produced a needle and were in the process of extracting some tail from the horse when I realised their expectation was that I would suture the wounds. It was a simple decision in the end and so the three of us gently cleaned the wound with a wooden pale of water and rag. The boys then did their best to secure and calm the horse whilst I sutured. It was messy but it was clean. The mare was relegated to the back without a load for the rest of the journey.

We left the family and headed further West the next morning. Although medicine is rudimentary out here, it is often the basics that can impact. Your worst experience can sometimes bring out your best experience and as a medic, the responsibility is huge, but this kind of challenge is specifically why I chose to be here in this capacity. Money can’t buy happiness and material things don’t always result in pleasure, but to adventure West in Mongolia with a family of Mongolian horseman and a team of likeminded people is something else entirely. Real happiness is through a shared experience. 

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