At the Third State Central Hospital in Ulaanbaatar are, left to right, Senzaaya, a scrub nurse, Saadi Ghatan, MD, Ariel Stock, MD, a neurosurgical resident at Montefiore Hospital, and Sloane Sheldon, PhD.
On Friday, May 12, Saadi Ghatan, MD, Chair of Neurosurgery at Mount Sinai West and Mount Sinai Morningside, and Sloane Sheldon, PhD, a clinical neuropsychologist in the Mount Sinai Epilepsy Program, boarded a ten-hour flight from New York to Istanbul. From there, they hopped on another ten-hour flight to Ulaanbaatar, the vibrant capital of Mongolia.
Thanks to support from the Virtue Foundation, a non-profit organization committed to transforming lives through health care, education, and empowerment initiatives, they spent the next two weeks providing medical services to epilepsy patients alongside a team of local doctors and volunteers representing a variety of advanced surgical and medical specialties.
On their first day in Ulaanbaatar, they arrived at the hospital at 8:30 am and met patients until midnight. Local neurosurgeon, Abai Siyez, MD, and epileptologist Bayarmaa Dondov, MD, had selected almost 150 patients for them to evaluate. In Mongolia, the options for epilepsy medications and pre-surgical evaluations are limited. Most patients can only get MRIs, which can be unreliable, and routine outpatient electroencephalograms (EEGs). With limited access to medication that could otherwise help, surgery becomes all the more important and sought after by patients and families.
Dr. Ghatan has a deep connection to Mongolia, as this marked his third visit to the country. His journey began in 2019 when he volunteered to teach local neurosurgeons advanced techniques and provide essential surgical procedures in pediatric neurosurgery. It was during this initial trip that he met Dr. Siyez at Third State Central Hospital in Ulaanbaatar. Dr. Siyez is the grandson of the man known as the founder of Mongolian neurosurgery. Dr. Ghatan introduced the team to neuroendoscopic surgery during that first volunteer trip. At the time, Third State Central Hospital lacked much of the surgical equipment required for these advanced surgical procedures.
Dedicated to his work and eager to advance in Neurosurgery in Mongolia, Dr. Siyez applied for funding from the Asian Development Bank to update the medical facilities at his hospital. Thanks to the grant funding he received, he successfully replaced his hospital’s outdated equipment and applied Dr. Ghatan’s teaching to treat new patients with state-of-the art equipment. One of Dr. Ghatan’s key aims in Mongolia is to continue collaborating with Dr. Siyez and sharing knowledge and techniques with local surgeons, allowing them to perform surgeries independently in the future.
Abai Siyez, MD, center, at the Third State Central Hospital in Ulaanbaatar with his team, performing a left temporal lobectomy surgery. Saadi Ghatan, MD, is shown on the right.
Dr. Ghatan and Dr. Sheldon screened patients in the first three days of their visit. Over the following week and a half, Dr. Ghatan, Dr. Siyez, and the surgical team successfully performed 21 epilepsy surgeries—an extraordinary number—ranging from temporal lobectomy to frontal and parieto-occipital disconnections, awake craniotomy, and more neuroendoscopy. As many of the locals are not fluent in English, Dr. Siyez plays an important role in making sure patients understand Dr. Ghatan’s communication, both culturally and medically.
Dr. Sheldon performed pre-surgical neuropsychological evaluations on patients. She administered patients with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), a test used for evaluating cognitive functioning. Understanding the limitations of the test, which is designed for an American population, she worked closely with an interpreter who helped ensure the accuracy and the cultural appropriateness of the testing materials. This was her first medical trip to Mongolia, and she was impressed by how open and eager the locals were to receive a neuropsychological evaluation. In addition to seeing patients, she also delivered a lecture on neuropsychology with neurologists and psychiatrists in the audience, which was a very rewarding experience.
For Dr. Ghatan, the trip was particularly meaningful because he was able to see and interact with the patients he had operated on during his previous trips.
“Seeing these lovely people living better lives with much more independence is gratifying,” he says.
Follow up, of course, is critical, and after these visits, Dr. Siyez shares regular updates about the patients they saw. They are planning to organize a monthly/quarterly case management conference to streamline information sharing.
With so much demand for these surgical procedures, and a successful track record of working with and training local doctors like Dr. Siyez, these two Mount Sinai ambassadors hope this continued connection will motivate the hospital in Mongolia to invest in more resources and focus on building better collaborations between neurologists, neuropsychologists, and neurosurgeons.
Dr. Sheldon and Dr. Ghatan are both looking forward making another volunteer trip to continue to improve the lives of people living with epilepsy and transfer knowledge to doctors in Mongolia. They were struck by how open and optimistic their patients were.
“The patients and their families were strong, resilient, and extraordinarily grateful,” says Dr. Sheldon. “I was so impressed by how open the locals are to take extra measures to ensure that they get the treatment they need and deserve.”