Uvs Province, Mongolia: The first snows of the winter of 2010 coat a ger in Uvs province. A pilot project in a remote province in northwest Mongolia has assisted health authorities and the local population prepare for the harsh winter. Last year, the country was hit by a devastating dzud, which is a devastating winter that follows a particularly dry summer. Access to healthcare was impossible for large swathes of the population, and infant mortality rates doubled. The government of the impoverished and sparsely-populated country declared a national emergency, and once the snows melted in spring, MSF sent an exploratory team to see what assistance could be offered.

Last year, Mongolia was hit by a devastating dzud – an extremely harsh winter that follows a very dry summer. With heavy snow, and temperatures as low as -40 to -50C, large parts of the rural population were unable to access any form of healthcare. Hospitals and clinics were damaged, infant mortality rose significantly and the government declared a national emergency.

Once the snow had melted in late spring, MSF responded by sending an exploration team, and recently completed a pilot project to help the population in one of the hardest-hit provinces prepare for the coming winter.

The pilot project took place in Uvs in the northwest of Mongolia, between September and the beginning of November, a province where around 70 per cent of the province’s 80,000 people were affected by the dzud.
“Last year’s dzud compromised maternal and neonatal health, and in addition, heating systems in health facilities were broken due to heavy use. Some local hospitals partially closed,” said MSF’s Head of Mission in Mongolia Christian Ferrier.

In winter, access to Uvs is possible mainly by plane and, during the summer, the province is a three-day cross country drive away from the capital Ulan Bator. Most people are nomadic herders who live in small groups of isolated gers, large tents situated in the rolling grasslands that are covered in snow between November and April and most make their living from raising goats, sheep, horses, camels, cows and yaks.

During last year’s dzud, a high percentage of their livestock was wiped out, making many herders destitute, and as a result, more vulnerable to illness this winter.

Five of the 19 counties in the province were targeted for the project, chosen because of their distance from the provincial capital and high levels of under five-year-old mortality during the dzud.

The project pilot involved a range of activities. These included improving infrastructure in five regional health facilities, providing a back-up supply of essential drugs and supplies in provincial and county hospitals, distributing basic first aid kits and health leaflets to 3,000 herder families, and giving refresher training and drugs to 16 community-based medical officers.

In the selected health centres, electricity supply and back-up were repaired and window insulation was improved in hospital wards.

“The local level medical officers had varying levels of education and age,” said Dr Mark Stover, the medical coordinator of the project.  "Some were in their 60s, but some were in their early 20s, but they were all very enthusiastic and studious."

“In the trainings, we focused on helping the medical officers recognize medical emergencies, and we tried to cover the illnesses that we were told were most common in the winter,” said Dr. Stover.

Giving the basic first aid kits and leaflets to the herder population posed a logistical challenge, because many people live in isolated gers and these residents have no access to mobile phones or landlines.

“In the end, the bush telegraph worked well. Word of mouth about our distributions was how the information was spread,” said Christian Ferrier.

The harsh winter has now begun in Mongolia, and in the spring, MSF team will return to evaluate the project. In the meantime, MSF is looking into starting projects in the capital Ulan Bator focused on tuberculosis, as well as the health needs of thousands of families who live in ger shanty settlements on the outskirts of the capital.