Unuudur spoke with State Honored Doctor and People’s Doctor A.Nota, who has been working as a neurosurgeon for 52 years. He currently serves as head of the Surgery Faculty at Ach Medical University and consultant neurologist at Achtan Hospital.

How long have you been working as a surgeon?

I’ve continued to do my job to this day and age. I was a surgeon at the General Hospital of Bayan-Ulgii Province between 1968 and 1975, head of the Neurological Surgery Department and consulting doctor at the Third State Central Hospital between 1976 and 2007, and have been working at Achtan Hospital since 2007. I’ve also been working as a consultant doctor at both the Central Military Hospital and National Trauma and Orthopedic Hospital since 1984.

Achtan is the first private hospital of Mongolia. The hospital’s management viewed that brain and spinal surgeries shouldn’t be done only at the Third State Central Hospital and neither should orthopedic surgeries be done only at the National Trauma and Orthopedic Hospital. Therefore, it decided to establish a faculty for these types of surgeries and offered me a job. I’ve been the head of this faculty since it was opened in 2007. I do all types of surgeries associated to the brain and spine here. However, we had to temporarily stop performing surgeries over a year ago due to deterioration of tools and equipment.

The Central Military Hospital launched an orthopedic and neurological surgery department in 2016 or 2017. As they have adequate equipment, it’s possible to perform all types of surgeries, including procedures for brain tumors, strokes, vascular diseases, abscess, neurosurgical disorders in children and more. We’re currently not doing surgeries as the hospital is being used for special purposes in connection to the global pandemic.  

Do you still perform surgeries yourself or let your team handle them?

I still perform surgeries, usually those that are more complicated. Resident doctors in training and medical students prepare everything for me so that I can execute the main part of the surgical procedure. I enter the operating room all the time but in some occasions, I step to the side and assist or consult younger surgeons to give them the opportunity to perform surgeries themselves. This is an interactive form of training. In general, whatever the profession might be, it’s not good to have people with the most experience do all the key work. We need to train our successors. It’s good to see how they are performing a surgery, guide them along the way and correct them if necessary.

You often say that a diploma doesn’t guarantee a specialization. When did you consider yourself a real surgeon? Did you intentionally choose this profession?

Yes, I chose this profession myself. After working for 10 to 15 years, I finally considered myself a real surgeon. I was dispatched to work as a surgeon at my home town, Ulaankhus soum in Bayan-Ulgii Province, right after I graduated from the Mongolian State University of Medical Sciences at the age of 22. That is how I got to work at an inter-soum hospital. Now that I think about it, I don’t know what I was thinking of going to such a remote place to independently perform surgeries. However, I did know that I needed to gain experience before then but that wasn’t a choice I could make at the time. The first surgical procedure I had to do was appendectomy, or removal of the appendix, for a seven-year-old boy. Two years ago, I returned to Ulaankhus and met that boy who is now a strong, healthy young man.

Over the last 52 years, how many surgeries have you performed?

Like the wise saying, “Learn from the past to know the future”, I’ve been writing up notes and reports on every surgery I’ve done. In total, I’ve completed general and neurological surgeries for more than 23,000 patients and provided ambulatory care for over 1.35 million people. Success rate of surgeries is at 95 percent.

What would you recommend for preventing diseases?

I believe that many things matter when it comes to living healthily, starting from health education and upbringing to devotion to develop and grow as an individual. But of course, things such as unbalanced diet, ignorance to changes in the weather, excessive drinking and smoking, too much intake of fat and sugar, poor stress management, and lack of exercise matter as well. These pose the biggest health risks.

There are congenital diseases like cerebral aneurysms. In the olden days, it wasn’t common for the cerebral aneurysms to leak or rupture, but lately, it’s happening much more frequently. The reason behind it is stress, among other factors. The public need to make an effort to improve their health knowledge. Rather than trying to cure diseases after being affected, people should focus on preventing them. There should be an efficient policy for preventing communicable and non-communicable diseases and the intersectoral collaboration should be improved. For example, the Ministry of Health needs to work more closely and efficiently with media outlets. If I were to give an example using my job, a television channel could regularly show the process of surgeries with explanation to make people understand why it is necessary to take good care of their health from an early age. It will make people realize that they should try to be more healthy as well as focus on the health of their children. I’m sure this would also lessen the number of people who decide to come to the hospital last minute.

How many neurologists and neurosurgeons are there in Mongolia?

Relatively few. Just over 50 if we were to add up those who have been recognized by hospitals and those working in provinces.

Isn’t your son a surgeon as well?

Yes, my son N.Baatarjan now works at the Third State Central Hospital. He is an exceptional surgeon who has a master’s degree and doctorate in medical science. He specializes in endovascular neurosurgery. I’m the first Mongolian cerebrovascular surgeon. Until recently, we had to create a hole in the skull and put clipping to treat cerebral aneurysm. Now my son and other surgeons are able to fix it through endovascular repair using a coil or coiling and stenting (mesh tubes), which is less invasive and doesn’t require opening up the skull.

Are surgeons who graduated in Mongolia able to perform this type of surgery?

That’s right. All of them graduated from the Mongolian State University of Medical Sciences and advanced their studies in one or more highly developed countries.

Can you share some of the papers you’ve written and achievements you made as a neurosurgeon?

Since the 1980s, my main area of expertise has been cerebrovascular disorders, its diagnosis and surgery. I’ve written academic papers on it and led four projects in this area, which have been handed over to the Science and Technological Fund. They’re now fully applied in practical work.

In 1993, I earned my doctorate with a thesis on “Diagnosis and Surgery for Brain Strokes” and another doctorate with a thesis on “Early Diagnosis and Surgical Procedure for Strokes caused by High Blood Pressure” in 2002. I published five academic books and handbooks, 288 scientific reports, and 42 academic articles on top of presenting my findings at international meetings 10 times and getting them published on foreign magazines. I have introduced to practice 18 methodological recommendations and 43 best practices, and acquired eight medical certificates for useful instructions.

I supervised doctoral theses of four doctors and five dissertations of master's candidates. In addition, I reviewed theses of five PhD candidates.

What do you plan to do in the future?

I’m developing a new project aimed to localize some neurology surgeries that aren’t performed in Mongolia. This includes surgeries for volumetric abnormalities of basal ganglia, which is one of the hardest disorders to cure, and microsurgery for complete removal of giant intracranial aneurysms. I also want to introduce minimally invasive surgery in Mongolia so that patients don’t have to travel abroad to get treatment for neurological diseases that require this form of surgery.