M.Otgonbayar: We’ve reached a level that can compete in foreign markets

Trans. by B.DULGUUN

Organ transplants and joint replacement surgeries have developed well in Mongolia. This is proof that Mongolian medical science is developing.

The following is an interview with the Head of the Rheumatism, Joint Studies and Joint Rehabilitation Center of the State Central Clinical Hospital (SCCH), Dr. M.Otgonbayar, about his profession and joint replacement surgeries in Mongolia.

You studied orthopedics (musculoskeletal system treatment) surgery in South Korea. When did you start  doing knee-joint replacement surgery in Mongolia?

I was a general surgeon until I changed my profession in 2007. At the time, many people suffering from joint disease and injuries used to get treatment abroad. Our hospital contacted South Korean surgeons to advance and train Mongolian doctors in advanced joint and bone replacement surgery, and I was selected to go to South Korea.

I studied for a master’s degree in orthopedics from 2009 to 2011 in South Korea. While studying, I returned to Mongolia, along with South Korean surgeons, and started performing joint replacement surgeries. Mongolian surgeons and nurses were trained to perform these new surgeries and technology at the same time. Since 2010, Mongolian surgeons have been  performing knee-joint replacement surgeries by themselves, without foreign surgeons. I graduated in March 2011 and have been doing joint replacement surgeries since returning to Mongolia.

Currently, how many surgeons specializing in joint replacement surgery are working at SCCH? Where were they trained?

Surgeons study orthopedics at the National Trauma and Orthopedic Research Center. This center has been performing this type of surgery even before the SCCH. All professional surgeons in this field at our hospital studied in South Korea. Even nurses have trained there for a certain period.

Since joint replacement surgery is rapidly developing in Mongolia, has this impacted spending on surgeries abroad?

Yes, it has. The number of patients traveling abroad for this type of surgery has drastically reduced in the last three years. The few that are going mostly have family members in that country. The majority of patients getting joint replacement are elderly people, so it’s difficult to travel to faraway places and resolve payment issues.

How much does it cost to get a joint replaced in South Korea?

To get a joint replaced, over 10,000 USD is required for the surgery, and if you add treatment and other costs on top of this, it’ll total around 20,000 USD. While studying in South Korea, I used to assist Mongolian patients getting surgeries. In addition to many complexities and expenses, the elderly patients had to adjust to the food, air and environment.

People who get this surgery in Mongolia receive a 50 to 60 percent discount on the procedure from the Mongolian Social Welfare Fund. Is it true that this surgery will be covered by health insurance in the future?

The world standard states that 70 to 80 percent of surgery expenses should be covered by health insurance and the remaining portion by the individual. Mongolia is aspiring to this transition. Demands for joint replacement surgery increased as social welfare started to cover a specific portion of the surgery costs. This was the perfect approach and strategy, as it enabled joint replacement surgery in Mongolia to develop rapidly. Now, Mongolia has reached levels that enable us to compete with foreign countries.

Since the SCCH commissioned knee-joint replacement surgery, how many patients have you had? On average, how many operations do you perform each week? How many operations have you performed since 2008?

Our team has done over 1,000 replacement surgeries. On average, we have five to six operations a week and 20 to 25 operations a month. There are many occasions when both joints have to be replaced. As we have inadequate beds and a huge workload, replacement surgeries aren’t conducted every day and are often delayed.

After surgery, the difficulties of patients are reduced considerably and they mainly focus on pain relief. Many new technologies are being introduced for blood transfusions. Can you elaborate on this?

Since 2011, we started operating with a special surgery team. The HELMET system is a very advanced technology used widely in developed countries for cancer prevention. Auto-transfusion technology, which replaces the patient’s lost blood during an operation, was introduced to Mongolia in 2012. A significant amount of blood is lost when knee-joints are replaced. This technology enables the transfusion of patient’s blood back to their body. It’s very dangerous to transfuse somebody else’s blood and the chances of encountering problems are high. The IB pump, a system for patients to monitor their pain, was introduced to the world. Another way to relieve pain is to input a tube between the spinal gaps of people who have had both joints replaced. Many people fear post-surgical pain so we try to reduce the pain as much as possible with globally recognized methods.

Since 2008, have there been very worrisome or problematic operations, or are they a unique occurrence?

According to global statistics, [chances of] post-surgical problems for joint replacement are around one to three percent. In Mongolia, it’s around one to two percent. If there’s a problem after a surgery, we resolve it immediately, as we conduct regular checks on patients. Problems occur mostly due to early or late cancer surgery.

Before reaching a level that requires surgery, is there a way to prevent joint illness and stop disease? For example, pills or vaccination?

Joint replacement surgery is connected to old age. Nutrition and fthe lexibility of cartilaginous tissue are reduced as people get older.  If you keep applying pressure with heavy weight, cartilaginous joints will wear away and  irreversible change will occur to bone structure, making it impossible to fix without surgery.

The majority of Mongolians have excess fat. There are shots for strengthening knee-joints and cartilaginous joint. Injections should be given at an early stage, before the bone is worn away, or it will be ineffective. Compared to Mongolians, Japanese and Koreans undergo this surgery at a very old age. This is due to many factors, including less excess body fat. Around 60 percent of Mongolians getting joint replacement are 60 to 70 years old.

What are the early stages of joint deterioration? Elders say that the pain is bearable for the first few weeks but worsens afterwards. What’s the reason for this?

You can define which stage joint disease is at with X-rays. It’s effective to get injections at an early stage, but it doesn’t mean the disease will disappear. It only prolongs the time before requiring an operation. Mongolian endoscopic joint surgery must be improved. If joint injuries aren’t treated immediately, replacement surgery will have to be done. A simple procedure using an endoscopic surgery is enough for a small cut in a cartilaginous joint.

At the moment, injections are provided without regard to stage of disease. When replacement surgery is inevitable, injections won’t have any effect. The pain will be reduced for only a short period. Injections can’t recover irreversible change in a cartilaginous joint.

Is it true that Russians come to Mongolia for joint replacement surgeries?

Lately, the number of Russians coming to Mongolia for surgery is growing. Joint replacement surgery is performed in Russia but the cost is high and this type of surgery hasn’t developed in some regions. More and more clients will come each year if we can provide them with good service. It’s possible to enhance medical tourism through this method. Our hospitals don’t have special tariffs for foreigners getting knee-joint replacement. They pay the same price as locals.

Where does the SCCH get its supply of artificial joints? Is the supply adequate?

The hospital signs agreements with companies with special licenses and orders equipment and artificial joints from the company. Only the surgeon in charge of an operation is able to order joints of a specific size and model. The surgical team must work closely with the supplying company.  Only then, can the surgery be successful. The same company is responsible for providing special tools, equipment and single-use tools and materials used during operations for bone grafting. The SCCH mainly uses high-tech German artificial joints.

Is this a client-first system?

Yes, it’s the most correct system. It’s an international practice. South Korea and America have the same system. In Russia, this process is conducted through tenders. The system becomes faulty when tenders are involved. What model and size joint required becomes clear during the operation, so pre-ordering large quantities through tenders is inefficient, as it’s wasteful.

Previously you mentioned that Mongolia needs to compete internationally. What are some other prospects for this field in Mongolia?

We strive to improve the quality of surgery even more. Patients in Mongolia with bone tumors between ligaments have no choice but to cut off that ligament. Now, we’re trying to avoid crippling our patients and have started performing surgeries for cutting off their ligament and replacing it with artificial joints and ligament.

You can get more information about our activities and operations from joint.mn.


Source: http://mongolnews.mn/1an5


Short URL: http://ubpost.mongolnews.mn/?p=11883

Posted by on Sep 11 2014. Filed under Prime Interview. You can follow any responses to this entry through the RSS 2.0. You can skip to the end and leave a response. Pinging is currently not allowed.

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