Mongolia faces shortage in rehabilitation therapists

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- First 6 occupational therapists graduated last summer -

Mongolia has made significant strides in developing its healthcare services but there are many areas that can be improved further. One of these areas is rehabilitation therapy services, which is crucial for restoring patients to their highest level of functioning.

There is a high demand for physical therapists (PT) and occupational therapists (OT) who can help the growing number of patients suffering from strokes and traffic accidents in Mongolia, according to research by Japan International Cooperation Agency (JICA). People who are suffering due to accidents, diseases such as arthritis, and those recovering from surgeries, stroke, or paralysis can experience limitations in self-care, impaired mobility, balance and coordination, limitations in joint strength or motion, speech and communication problems, as well as changes in memory, thought processing, reasoning and rational thinking. Therapists can help these people regain their abilities and independence.
O.Zolzaya, head of the Rehabilitation Therapy Department at the Second State Central Hospital, explained the difference between a PT and OT.

“People who had a stroke usually can’t walk, stand up, go to the bathroom, or get on and off the bed. Specialists who help patients do these activities on their own by helping them regain their strength, mobility and fitness are called PT. Currently, Mongolian PT have work experience of six to seven years. The Second State Central Hospital employs four PT at the moment. Meanwhile, an OT helps patients perform daily activities.

For example, a brain stroke patient loses his/ her ability to comb their hair, wash their face, brush their teeth, take a shower/ bath, cook, and eat. They also face cognitive disorders, which means that they can’t differentiate colors, calculate, and/ or recognize their family. OT helps patients in these areas.” 

Japanese volunteer training OT

An expert in this field said that large hospitals in Mongolia have only two to three PT, but are in shortage of OT. The first group of Mongolian PT graduated in 2011 and six people graduated as OT in June 2018. 

As occupational therapy is new to Mongolia and there aren’t specialists with adequate experience or enough people to work as a team, the Second State Central Hospital requested JICA’s assistance so that they can bring a Japanese OT volunteer to train the staff. Accordingly, JICA brought experienced Japanese OT Rika Nonami to Mongolia for a period of two years. She used to work as an OT in Japan, mainly providing outpatient therapies, before starting to volunteer at the Second State Central Hospital a year ago. 

Director of the Second State Central Hospital G.Bayasgalan noted, “Our hospital and JICA have been partners for many years. Twenty years ago, we were able to purchase advanced medical equipment with grants from JICA and they are still in use. Moreover, we have been receiving volunteers from Japan to improve our healthcare services. Right now, the fifth volunteer, Rika Nonami, is working with our rehabilitation therapy staff.”

“Rehabilitation therapy is evolving in the modern time. In the past, rehabilitation consisted of massages and core treatment. Nowadays, it involves physical and occupational therapies which are aimed to help people regain their ability to perform daily tasks. In this sense, we requested Nonami’s assistance for importing and learning Japanese rehabilitation methods as she is a specialized OT. She has been with us for a year and during this time, she personally provided occupational therapy to patients while training our staff. In particular, OT plays an important role in helping patients who had a stroke get back their normal abilities.”

“We’re learning many things from Nonami. She has been organizing training for our staff and helping to localize Japanese know-hows in Mongolia,” said Department Head O.Zolzaya.
On February 15, Nonami was doing therapy with two people when I went to the hospital as part of JICA’s press tour. One of the patients was an elderly man, called S.Asanbaatar, who had been receiving rehabilitation for the last seven years after having a brain stroke. The other was a middle-aged woman who had been receiving rehabilitation for five years. 

Nonami helping Asanbaatar do finger exercises
Nonami helping Asanbaatar do finger exercises

“I have been rehabilitating for seven years,” S.Asanbaatar said with some difficulty in pronouncing the words. “The Japanese doctor taught me a couple of exercises. I’ve been improving through every session. I had a stroke while working and I learned that the only way to regain my ability to function properly is through occupational therapy.”
His therapist T.Gantsetseg said that S.Asanbaatar was very weak at first but has been showing fast recovery through exercises. 

“S.Asanbaatar couldn’t walk after having a stroke but now, he’s able to walk on his own. The biggest challenge he faces now is doing complex movement with his fingers. Therefore, we’re focusing his therapy on exercises to improve his finger dexterity. This patient has been undergoing occupational therapy for a year. It has enhanced his hand movement, which will enable him to do daily task such as wash the dishes, peel potato, cook, and brush his teeth.”

Nonami says she works with five to 10 patients on a daily basis at the hospital. During the first eight months of her volunteering, Nonami helped the department create a database on patient’s information, which helps speed up and provide tailored treatment for each patient. Personal health record for rehabilitation is said to be essential as it allows therapists to know the exact condition of a patient, plan out a rehabilitation session for each individual, and keep track of their recovery.
So far, the new database of the Rehabilitation Therapy Department has health records of more than 100 patients.
One of the difficulties in providing effective rehabilitation in Mongolia is the short period of time patients can stay at the hospital after surgery to receive rehabilitation, Nonami said. 

“Japanese hospitals provide inpatient rehabilitation services for 180 days after the patient undergoes surgery, but in Mongolia, patients are allowed to stay up to 10 days in the hospital after surgery and receive rehabilitation for only five days. This is a very short amount of time. There’s so much to do in this time. In Japan, patients are allowed to go home when they’ve learned to cook and perform daily tasks. In Mongolia, patients can’t stay too long in the hospital so they receive rehabilitation by coming to the hospital from home,” she stated. 

“When I first arrived in Mongolia, I was stuck when I found out about the short amount of time I was given to rehabilitate patients. There’s so much we need to do but the services we can provide were limited. Now that I’ve gotten used to the system and know that patients can come back and forth to the hospital, I’m able to provide smoother occupational therapy.” 

Before coming to Mongolia, Nonami heard that Mongolian human resources weren’t trained in occupational therapy but while working, she learned that Mongolia is quite developed in rehabilitation services and is continuing to advance. 

Rehabilitation burdens patient’s family the most

Mongolian therapists underlined that not only the patients but also their family need to be committed to the therapy to see the optimal recovery. They added that the rehabilitation tends to be a tedious course for family members as they’d have to bring the patient to the hospital, take them back, pay for their session fee, and help them practice.

“Patients must receive rehabilitation for at least three months to recover and this period can stretch to six months, nine months, a year or more depending on the patient’s condition,” said O.Zolzaya. “Since patients can’t be admitted to the hospital for a long period of time, they can only receive rehabilitation by commuting between their home and the hospital. This is very hard for the patient’s family because they need to bring the patient back and forth to the hospital even though they have work. This is time-consuming and financially straining.”
Rehabilitation therapy was provided for free of charge until last year when the government set a tariff. Now, patients have to pay 1,500 MNT per day. 

O.Zolzaya gave further details about the tariff. 

“The fee for rehabilitation therapies is an issue because the health insurance fund doesn’t cover it. We’ve studied practices of many hospitals from across the world and they all cover the bill for at least two years through health insurance. Mongolia doesn’t have this kind of mechanism. People with good livelihood or have family members who can bring them to the hospital and take them back home on a regular basis are coming for rehabilitation at our hospital. There are many people who can’t afford this. This means that they are staying at home without doing the necessary exercises or getting rehabilitated.”

The department head says the health sector is discussing this matter and trying to figure out a way to include rehabilitation in the list of insured healthcare services. However, nothing concrete has been made. 

As Nonami will return in 12 months when her volunteering period ends, the Second State Central Hospital has requested JICA’s assistance in bringing another volunteer to help train its staff in the complex field of occupational therapy. As a response to the request, JICA has started looking into finding suitable volunteers.

Dulguun Bayarsaikhan