Strengthening Surgical Collaboration in Mongolia: Songinokhairkhan District Hospital (Part 1 of 2)

In June of 2025, Dr. Sharon Ong’s surgical team divided its time between two hospitals in Ulaanbaatar. The program began with a two-day visit to Songinokhairkhan District Hospital on Monday and Tuesday, followed by three days at the National Cancer Center (NCC) from Wednesday to Friday. An additional teaching day was held the following Monday to reinforce learning.

Songinokhairkhan District Hospital

The District Hospital extended a warm welcome to the visiting team. Preparation for the visit began a month earlier with a virtual meeting to identify local needs and establish a plan. The initial objectives included support in ICU care, anesthesia training, and general surgical/thoracic procedures.

Unexpectedly, two anesthesiologists scheduled to join were unable to attend, leaving only Dr. Iyer (anesthesia) and Dr. Ong to deliver the program. Despite the reduced numbers, significant progress was achieved.

The surgical program began with three laparoscopic type 4 paraesophageal hernia repairs. By the third and final case, it became evident that the hospital had run out of appropriate sutures. In addition, the endostitch instruments brought by the team could not be used due to a broken flash sterilizer; the only available high-temperature sterilizer risked damaging the devices. As a result, the visitors demonstrated intracorporeal suturing techniques, ensuring the procedures could continue safely with the resources at hand.

The team also carried out a video-assisted thoracoscopic sympathectomy. During this procedure, Dr. Iyer provided instruction on double lumen tube intubation, which proved to be a valuable training opportunity for the anesthesia staff. Throughout the visit, the local anesthesia team gained experience in regional blocks, double lumen intubation, and perioperative management of complex intrathoracic cases, including the management of large mediastinal dissections associated with paraesophageal hernia repair.

Overall, the visit to the District Hospital was productive, and the staff were highly engaged and eager to learn.

Reflections and Recommendations

The experience at Songinokhairkhan District Hospital highlighted both successes and areas requiring further development. Recommendations for future collaboration include:

• Strengthening basic anesthesia care, with particular emphasis on regional blocks.

• Expanding opportunities for basic surgical training, with the goal of empowering local surgeons to manage more cases independently.

• Reassessing the role of thoracic surgery at the District Hospital, as advanced thoracic interventions may not be appropriate at this site. Instead, collaboration should focus on connecting interested staff with training and resources that align with the hospital’s scope of practice.