Project Design & Management Seminar

Back in February, the PC/Mongolia training team told all of us PCVs about an upcoming Project Design & Management (PDM) seminar for PCVs and one of their HCA or community counterparts to work on the design and planning of a specific project. In order to be invited to the seminar, we first had to conduct a needs assessment in our community to determine the most pressing issues and then come up with a project idea to address those issues.

So my supervisor and I (who really wanted an excuse to travel out of Zavkhan on Peace Corps’ dime) worked hard to complete a needs assessment before the deadline, which was right after Tsagaan Sar of all times. We reviewed statistics and health indicator reports from the Ministry of Health, along with hospital records and health department reports from here in Zavkhan. We also conducted key informant interviews with the director of the Public Development Division at the Zavkhan Governor’s Office, the treatment director at the Central Hospital, the head doctor and advisor of the Children’s Division at the Central Hospital, and the director of the Children’s Hospital. We conducted informal interviews and discussions with staff members and parents of patients at the Children’s Hospital, and we examined what medical equipment was available both in the Central Hospital and the Children’s Hospital.

Our needs assessment revealed that the infant and under-5 mortality rates are significantly higher in Zavkhan aimag than both the country average (all of Mongolia) and the aimag average (all the aimags minus UB). So basically, lots of babies and little kids die in this part of the country.

Sorry, that was depressing. Please look at this cute Mongolian puppy playing in the snow

Sorry, that was depressing. Please look at this cute Mongolian puppy playing in the snow

This is believed to be due to the fact that there are no emergency facilities for infants and children in Zavkhan. The Central Hospital has an emergency department, but it is not equipped to treat infants and children and is not staffed with pediatricians. So if a parent comes to the ER with a very sick child, they will either have to wait for a busy pediatrician to come there from another part of the hospital (and even then, there will likely not be the necessary medical equipment) or they will be sent to the Children’s Hospital, which is a few blocks away. But the Children’s Hospital does not have an emergency department at all, so even if the parent was able to finally get a pediatrician to look at their child, they wouldn’t have a monitor to see what was wrong with the child, or a respirator to hook the child up to, etc.

Our main project idea is to develop a children’s emergency department at the Children’s Hospital. We have identified 3 rooms on the first floor of the Children’s Hospital that could be converted into a 5-bed ER, and there are 6 doctors and 8 nurses from the Central Hospital that could be transferred to the new department so that it could be staffed 24 hours a day by at least 1 doctor and 1 nurse at all times. There is even a medical engineer at the Central Hospital that could train the staff on how to use the emergency medical equipment.

But what we need is—you know—the actual medical equipment. The Ministry of Health has a list of “hospital standards” that specify what equipment and supplies are deemed necessary for each ward/department of the hospitals. There are sections of that standard for infants and children and for emergency facilities, but of course our facilities don’t have most of that equipment, or the money to get it. I’ve looked into some of the numerous NGOs that collect used hospital equipment from developed nations and donate them to clinics and hospitals in developing nations, but those organizations generally send the medical equipment in those big 40-foot shipping containers to the nearest sea port, and the receiving organization is responsible for getting it the rest of the way. You may recall that Mongolia is a land-locked country, so going through one of those programs would require us to have the container shipped to a port in China, then put on a train on the railroad that comes up to UB, and finally put on a giant truck coming out here to Uliastai. So, just a bit of customs and legal paperwork and crossing our fingers that it wouldn’t just disappear somewhere along the way (as so many care packages do when they’re sent to Mongolia through China). Oh, and somehow paying for the shipping container’s long land-bound journey. So only slightly more complicated than finding a pot of gold to just pay for new medical equipment directly.

Anyway, there’s your background for our project. We and 20 other PCV/counterpart pairs were selected to attend the 3-day PDM seminar, which took place last week. It was held at a “resort” about 30km outside of UB, in a quaint little mountain area that had plenty of what looked like summer vacation homes nearby.

The resort

The resort

The lobby

The lobby

The view

The view

Yeah, Mongolian homes do not look like that

Yeah, Mongolian homes do not look like that

The seminar consisted of sessions on writing goals and objectives, creating a logic model and action plan, identifying resources, monitoring and evaluation, budgeting, and proposal writing. There was also a session on Peace Corps funding resources, which wasn’t as helpful for me and my supervisor because our (admittedly large-scale) project is not eligible for those smaller grants. So my one qualm with the seminar was that they didn’t cover other funding sources. If we do end up going the route of having an NGO ship us a bunch of medical supplies overseas, most of those programs do require a sponsorship fee of up to $25,000. Obviously our hospital does not have that money, so I’m looking into other entities that could help fund the project, but I have no experience with waltzing up to a company and asking them for money, and my counterparts didn’t even think about that as an option, so I’m assuming they don’t have much experience either. But outside of that, the seminar was extremely helpful. There was plenty of time for us to work in our pairs to apply what we learned in the sessions to our own projects. But now there is a lot of work to do to move forward.

According to the seminar schedule, we would be heading back into the city on Saturday morning. But since our flight back to Uliastai was at the ungodly time of 6:50am on Saturday, me, my sitemate, and our counterparts were supposed to be taken back on Friday evening after the last sessions. But then, during the closing session, we were informed that our flight had been delayed until Sunday morning (on account of a snowstorm that had gone through Zavkhan on Friday and was heading toward UB). So we hung around at the resort for another night and left with everyone else Saturday morning, with the snow already coming down.

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But having our flight delayed meant an entire free day to spend in UB! It would have been nicer if that day hadn’t been marred by a snowstorm that I did not have the appropriate clothes for (It’s supposed to be spring! It was in the upper 40s when I left to come to UB!). Nevertheless, I managed to trek to several places, including a yummy café for brunch:

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French toast and a chocolate milkshake (with a shot of espresso)

And several stores that sell stuff you can’t find out in Zavkhan, like cheddar cheese, popcorn, peanut butter, Vanilla Coke, etc., along with American goodies that can only be found in a select few places in UB, like cereal and Kraft mac & cheese. Yes, I managed to find what I’m pretty sure was the last box of mac & cheese in the entire country. I didn’t even know they sold it in UB, and I always get tons of it sent in care packages because I could probably live off the stuff. Then I saw one lone box on a shelf in one of the stores and asked a worker if there were any more. She informed me that there was a currently a shortage of the stuff.

Seriously, a shortage of Kraft mac & cheese in Mongolia.

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I’m not sure if it had something to do with the recent recall by Kraft, though I can’t imagine Mongolia being a place that pays too much attention to things like recalls due to tiny pieces of metal possibly being in processed foods. But I also can’t think of any other reason for the shortage. When I tell Mongolians about macaroni & cheese, they seem to be unfamiliar with the stuff. And I know there are a fair share of expats who live in UB, but unless they’re all my clones, I can’t imagine them eating enough of it to cause a shortage. Anyway, while visiting a few other stores I looked for any more of the blue boxes, with no luck. I was either told about the shortage again or ensured they would be getting more in next week. Thus, I may have gotten the last box of Kraft mac & cheese in Mongolia, and definitely ate it for dinner the day I got back to Uliastai.

After shopping, I headed back to one of the city’s hostels that at any given time are likely to be filled with PCVs.

...and their stuff

…and their stuff

I paid for my bed (the equivalent of about $4) and took advantage of the free wifi until dinner. A group of us went out to a really nice bar & grill, where I got an actual Caesar salad (in a lot of restaurants, even if they have “Caesar salad” on the menu with a picture next to it looking all appetizing, you’ll get…something else…that should be illegal to call a Caesar salad), shared a pizza, and had a tequila sunrise and a B-52 that I didn’t know was really a Flaming B-52 until the waiter came with a lighter to set my shot on fire.

I somehow managed to not catch my face on fire (yeah, I don't drink flaming drinks very often...or any kind of drink...)

I somehow managed to not catch my face on fire (yeah, I don’t drink flaming drinks very often…or any kind of drink…)

After dinner, we went back to the hostel. While others were being sociable, I went to bed to try to get at least a few hours of sleep before I had to wake up to catch my stupidly early flight. But I did spend most of the flight sleeping, and then proceeded to spend a large portion of the rest of the day napping, waking up to get groceries and to eat my mac & cheese dinner. Then it was straight back to a regular ol’ work week.

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First Trip Away From Site

This past Wednesday, some of my coworkers at the health department asked me if I wanted to come with them on an overnight trip to one of Zavkhan’s soum hospitals for an inspection.

Now, just the previous weekend, some of the PCVs here in Zavkhan had planned to go to Govi-Altai aimag (which borders Zavkhan to the south) to have an early Thanksgiving get-together with the PCVs there and to go to a camel festival that was happening that Sunday. But Peace Corps has this little policy where new Volunteers aren’t allowed to leave their site for the first 3 months (unless it’s work-related travel with their HCA, official Peace Corps business, or travel for medical reasons). Guess when my cohort’s 3-month mark was? November 17th, the day after the freakin’ camel festival! One of the M24s here in Uliastai even called our Regional Manager to see if she would give us some leeway, but no. The M24s still could have gone without us M25s, but they were nice enough to stay and keep us company, and told us we could try to find another camel festival to go to next spring (when it’s not ridiculously cold). I will ride a camel before I leave Mongolia, dammit!

Anyway, I was pretty bummed about that, so when my coworkers invited me on their little trip, I was all for it! Sure, there wouldn’t be Thanksgiving dinner or camels, but I would be going on a trip! Woohoo! And they even gave me a full 24 hours notice (yes, we left the day after they invited me).

That Thursday after lunch, the 5 of us (me, the director, 2 health department specialists, and the driver) packed into a Land Cruiser for the 3.5-hour drive to Otgon soum, about 130 km southeast of Uliastai. The drive could best be described as “whiplash-inducing”, especially since I ended up in the back middle seat with no headrest, and to say the road was unpaved would be an understatement. But there was plenty of nice scenery to look at, although the windows were so fogged up that I couldn’t really take pictures. We did stop at one point, and I managed to snap a few photos:

Yes, it's been snowing

Yes, it’s been snowing, even in the technically-desert

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But then, disaster struck! While I was handing my camera to one of my coworkers so she could take a picture of the rest of us, she/I accidentally dropped the camera, which (of course) landed lens-down in a pile of snow-covered dirt. We tried to wipe off as much dirt as we could with the one napkin we had, but decided to try to fix it once we got to our destination.

At about 5:30, we finally arrived at the Otgon hospital:

Or "Health Center" if you want to be all technical

Note: photo taken the next day, as my camera was still out of commission at this point

We were shown to our room, which was a patient room with 4 hospital beds. And considering the “hospital” only had 10 beds in total, we were lucky they didn’t have a bunch of inpatients then. You may remember there being 5 of us, so the driver stayed the night at a friend’s home.

First we were served dinner, which consisted of bread and butter, potatoes, extremely fatty beef ribs, blood-filled intestines, and milk tea. I ate as much bread and potatoes as I could to avoid eating too much of the meat/intestines. I really don’t think I’ll ever get used to traditional Mongolian food.

After dinner, we started the hospital inspection while the driver tried to fix my camera (using a needle to try to get the dirt out from around the lens, and putting those valuable medical supplies to good use).

I followed my coworkers as they went around to all the hospital’s rooms, interviewing patients about the care they received there, inspecting the medical equipment and supplies, etc.

Fun fact: there’s no running water out in the middle of nowhere, Mongolia, even in the hospital. So we, along with all the hospital employees and patients, had to use outhouses behind the hospital, and all the sinks inside were “dry sinks” like the one I have in my ger. So I had one night of sleeping in a room with heating, but still had the joy of running to the outhouse in the freezing cold.

After the inspection, we played the one card game that Mongolians seem to know, called khuzur. I’ve mentioned this game before when we played it after a hike with my coworkers a couple months ago, but never really caught on to how to play. I finally found a blog post that actually describes how to play the game (although my coworkers seem to play a slightly different variation). And this time, my coworkers were willing to actually explain it to me so that now I mostly understand what’s going on.

And of course, one of my coworkers busted out a bottle of vodka. Once they started insisting we had to finish the bottle that night, I finally asked why? I’ve noticed that once a bottle of alcohol is opened, Mongolians never stop drinking it until it’s empty. Apparently it has something to do with luck. So we did finish the bottle, with just a little bit of help from me, because I hate vodka unless it’s in a cocktail.

I didn’t sleep too well that night because my director snores like crazy. In the morning we were served more bread and butter and a kind of porridge, then the 2 specialists went off to meet with the hospital workers to discuss what they found during their inspection and offer suggestions. The driver came back and took the director and I down to the river by town to get a view of Otgontenger, the mountain I’ve mentioned before that is the tallest in Zavkhan (and the Khangai range) and capped with a permanent glacier. The driver had managed to fix my camera, so I was able to get pictures!

Ok, so it's still pretty far away. Despite being located in the Otgon region of Zavkhan, the mountain is still about 70 km away from the Otgon soum

Ok, so it’s still pretty far away. Despite being located in the Otgon region of Zavkhan, the mountain is still about 70 km away from Otgon soum

What a town of less than 3500 looks like

What a town of less than 3500 looks like

After our little sightseeing detour, we headed back to the hospital and played cards again until lunch. My coworkers started eating the leftovers from dinner the night before (which had just been sitting out in the open since then), so I assumed that was our lunch. They forced me to eat a couple pieces of meat, and then a hospital worker came in with a big bowl of fresh buuz. Good thing I just risked food poisoning thinking no other food was coming…

Then the others went off to another meeting while I took a nap because I was really tired after not getting much sleep and not having any coffee. At about 2:30 that afternoon, we got back into the Land Cruiser, and I assumed we were heading back to Uliastai. But not before a “small meeting” with the soum‘s mayor, which ended up being an hour long.

Then we were really on our way back. We got another view of Otgontenger and some more photos:

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About an hour later, we passed by a huge herd of horses:

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It was impossible to capture just how many horses there were in just a few pictures, as there were a ton more over the next hill

It was impossible to capture just how many horses there were in just a few pictures, as there were a ton more over the next hill

We passed by a herder and our driver stopped to ask how many horses were in his herd: 4,000!!! Four-thousand horses and just 4 herders to keep track of them!

In the freezing cold no less

In the freezing cold no less

The rest of the drive was pretty uneventful, outside of the continuing whiplash. It was dark when we finally got back to Uliastai, and it was insanely cold in my ger, but it was good to be home.

Oh, remember how I mentioned food poisoning earlier? Yeah, that’s because I was definitely nauseous and throwing up the next morning. My supervisor asked what I had eaten during the trip and also thought that it was something I ate. Mongolians may be perfectly fine eating approaching-rotten meat because they have iron stomachs, but I cannot without suffering the consequences. So I spent the whole day in bed, but I’m feeling much better now!