It’s been half a century since Mongolia established a department for cardiac surgery. However, numerous documents prove that Mongolian doctors had performed cardiac surgeries such as coronary artery bypass craft before the department was established in 1957.
State Honored Doctor Ts.Davaatseren who serves as the head of the Cardiac Surgery Department at the Third State Central Hospital details on the development of heart surgery in Mongolia, challenges and ambitions in the following interview.
In the past, parents used to decide professions for their children. Did you become a doctor on your own will or was it decided by your family?
I was born in Tonkhil soum of Govi-Altai Province. I’m the second oldest out of nine children. I used to tell people that I would become a doctor even as a kid. My father was the head of the Union’s Raw Materials Office, which was similar to a modern exchange. My mother was a cook at a school cafeteria. Back then, they were considered to be “educated”. My parents were very supportive to not just me but all of my siblings, telling us to do whatever we wanted to. But my father used to say that such a large family should have at least one doctor. I’m grateful to both of them for helping us finish university.
I’m the only doctor in our family -- even among relatives. I never pressured my children to become a doctor though. They probably realized that it was a difficult job while watching me work day and night, and not being able to spend much time at home.
You’re quite notorious as “heart doctor Davaatseren” and student of State Honored Doctor Ts.Bundan. How did you become a cardiac surgeon?
Upon graduating the Mongolian State University of Medical Science in 1984, I was assigned to the Central Hospital of Govi-Altai Province as a surgeon. Back then, doctor Ts.Bundan was the head of the Cardiology Department [under the Institute of Medical Sciences] and I got the chance to do a five-day training there before leaving the city. However, Ts.Bundan decided to keep me at the department and make me into a cardiac surgeon. I was young then and even the higher-ups gave permission, so instead of going to the countryside, I became an academic staff in cardiac surgery at the Institute of Medical Sciences. Basically, doctor Ts.Bundan took me under his wing. After working at the institute for three years, I transferred to the Third State Central Hospital and have been working here for 31 years.
Did the Cardiac Surgery Department have sufficient personnel and equipment when you first joined?
When I came to work at the department, only the founding members who pivoted the cardiac surgery in Mongolia were here. Thanks to my teacher Ts.Bundan, I got the chance to work with the best doctors in the country and made it this far. Back then, we systematically trained the staff and assigned them into teams. No matter how great the team is, it’s impossible to make a medical advancement if there’s a shortage of equipment, medicines and other necessities. As a person who’s been working in this sector for 34 years, I know that Mongolian doctors had to go through hard and challenging times to advance the sector to its current height.
We used to perform cardiac surgeries under extreme conditions. The Cardiac Surgery Department became stationed at the Third State Central Hospital in 1985. There was nothing to be considered as equipment. It’s impossible to do a heart operation with one or two surgeons – it requires a whole team. I’m not implying that other specialized surgeons have it easy. Every specialized surgery is difficult but among them, cardiac surgery can be extremely complicated.
During the revolution days, we used to measure the duration of cardiac surgeries in minutes, not hours. As doctors say, it was a time when we performed surgeries in refrigerated conditions. We sedated the patient and covered them with ice to lower their body temperature. Once that was done, we cut open their chest and the counting started as soon as we touched the heart. The surgery must be completed in under 10 to 15 minutes. A second lost could account for a life.
Back then, I was so afraid and depressed that I asked my teacher to allow me to become a general surgeon or go back to Govi-Altai. When I told him I’m not skilled enough to even cut open a person’s chest, he was really disappointed with me. A while later, he told me to work in Bayan-Ulgii for six months and find out their situation. He was a really intelligent person with good management skills so now that I think about it, he did it to help me overcome my fears. He called me back less than three months later. After the trip, I felt better but was still anxious. Even so, I was able to gain experience and become better accustomed to my work thanks to many great people in my life.
Cooling the body with ice to perform a heart surgery sounds very strange. Why was this necessary?
Steadily cooling the body before and during surgery enables the brain and other organs to “wake up” faster. As we stop the heart from pumping to perform the surgery, we have to use the cooling method or other organs could die. Starting from bringing the ice from the cooler, we had so many things to do. Nonetheless, the surgeries were effective. From what I know, this method was used for seven to eight years.
Now, we have all kinds of equipment for it. We don’t have to worry about having to complete the surgery in 10 minutes. This makes us less nervous, anxious and fearful.
Our working condition has improved tremendously particularly over the past decade. After the surgery, we’re able to check the result through micro X-ray. In the past, we presumed the surgery was successful if the heart started beating. Nowadays, young people don’t have much to worry – all they need to do is study. However, no matter how much we go abroad, large hospitals don’t allow us to perform surgeries. They give us general instructions. It takes a minimum of 10 years to learn to operate equipment required for heart surgeries, and at least 20 years of work experience to be able to operate on someone’s heart. Even the angle of the needle is important.
Can you talk about your first heart surgery experience?
One time, my teacher called me, gave me a rundown of a patient’s condition and ordered me to study the techniques required for the surgery. After some time, he checked up on me and, like always, taught me the right technique and order. When I entered the surgery room, everyone was in frenzy as if the patient was in cardiac arrest. I was so afraid that I told my teacher I couldn’t do it. He was so angry but since he’d already diagnosed the patient and knew what needed to be done, he told me to perform the surgery as if he weren’t there. “Will you do nothing and let this patient die? If not now, when will you ever learn to operate on a patient?” he said before leaving the room.
I was having cold feet but I did as my teacher taught me. After the surgery ended successfully, my teacher congratulated me and that’s how I got rid of that huge fear in me. To this day, I have come across many life-and-death situations. There were times I regret. Besides the doctor’s skills, the patient’s condition can affect whether he or she survives. That is the reason we stopped doing surgeries with guidance from a professional in the room since three years ago. Now, surgeries are completed according to medical standards and regulations. I mean, it isn’t right to ask family members to sign a consent form when we know the patient can’t handle the surgery.
The Third State Central Hospital is striving to be able to treat all types of heart defects and disorders by 2020. Do you think the hospital can achieve this?
There are many types of heart defects and diseases. I’ve been learning more and more treatment methods to become able to perform very complicated surgeries. For the next 10 years, I’ve set a target to do heart transplant surgery in Mongolia. This year, for example, we started doing two new types of surgeries that patients had undergone overseas in the past. These surgeries were aimed to treat cardiac muscles damaged due to the narrowing or blockage of coronary artery, and repair or replace heart valves. Both surgeries were successfully completed. Both patients were in serious condition and needed artificial heart pump. We also operated on a woman of over 60 years of age who had a tear in her cardiac muscle due to changes to her aorta, which stopped her heart form pumping blood. However, the surgery was a success and all three have been discharged from the hospital.
Before, people had to go abroad to get around 10 types of heart surgeries but now six of them are available domestically. The four surgeries still not available in our country are combined congenital heart surgery, and surgical procedure for people whose cardiac muscle is in very bad condition and is facing several valve-related defects. We can’t operate if there’s an aortic aneurysm (abnormal bulge) in the wall of the major blood vessel (aorta) that carries blood from the heart to the body. The same goes for patients who developed one or more abdominal aortic aneurysm.
Our department currently has 40 beds. The 10 specialized surgeons in our department perform around 70 types of surgeries for congenital and acquired heart disease and defects. We conduct only 800 or so cardiac surgeries a year. Two hundred of them are open surgeries. There are many operations we designed or localized to Mongolia as well. We’re currently laying the foundation for conducting heart transplantation surgeries domestically, which I mentioned before. Although we haven’t created the necessary conditions for performing all types of hearts surgeries and procedures in the country by 2020, the fact that we were able to reduce the unavailable surgeries to four is a huge achievement.
How should the government support to make heart transplantation available locally?
There are many obstacles we’re facing in terms of finance. Most developed and developing countries spend a minimum of six percent of its state budget on health sector every year. In Mongolia, less than three percent of the state budget is allotted to the health sector. However, instead of begging the state to provide us adequate funds, we focused on enhancing our skills first and we were able to do it. We have also improved our foreign relations significantly over time. We work with American, Dutch, Korean and Chinese cardiac surgeons, but we lack necessary injections and medicines due to the small budget. For instance, we’re in an urgent need for artificial lung and heart machines for infants. We also need left ventricular assist devices, stem cells and medical implants. If we resolve this problem, we’ll be able to perform the four locally unavailable surgeries I mentioned before. It’s not that Mongolian doctors aren’t able to perform these surgeries, but lack the equipment and provisions required for these operations.