Participants: Corinne Wyder (CW), Raoul Schmid (RS)
1. Prerequisites
The 2024 elections resulted in a narrow victory for the People’s Party, meaning that many decision-makers remain in office. The cooperation with NCMCH1 has become increasingly difficult for our local representatives, as they are barely tolerated by the hospital management at the origin of the screening program. In particular, Tsoogii, the head of the outpatient department, has opposed SMOPP and is demanding more power and competence, respectively acting externally as a trainer without consent and getting paid for it. It is expected that SMOPP (our local staff) will be pushed out of NCMCH1.
Our visit was unfortunately overshadowed by a severe acute illness of Bayalag’s father. As a result, she was heavily burdened and only partially available to us. The “tentative agenda” became even more unpredictable because of this… The unbearable traffic in UB makes car travel at certain times almost impossible. The few kilometers between the clinics often take 2-3 hours.
2. Cooperation with the National Centers for Maternal and Child Health (NCMCH)
According to our trusted contacts (Bayalag BM, Tulgaa MU, Enkhtur, Soyoloo), there are efforts, for example, from the leadership of NCMCH1 to take over hip screening. Many of the mentioned individuals have, in recent years, moved to NCMCH2, which is located in the southwest near the former international airport. Consequently, the responsibility for screenings and therapies will be distributed across multiple locations in the future.
3. Screenings and Preventive Therapy
These have so far been largely ensured by BM and NCMCH1. In the future, NCMCH2, the modern Songinokhairkhan District Hospital on the western outskirts, and Maternity Hospital 3 in the eastern part of the city are also expected to gain this competence. These clinics are to offer splint therapy in addition to screenings and examinations for group B hips in Zukung. All the mentioned clinics were visited by our delegation and qualify, in our opinion, with supervision from Tulgaa and Bayalag. With this step, we pursue two goals:
- Distributing responsibilities across multiple shoulders and away from NCMCH1 (where takeover plans have been reported).
- Better integration of the mentioned clinics into the project, reducing loss from screenings through improved geographical connection (proximity to the maternity clinic and familiarity with the institution).
4. Training
On August 26 and 27, 2024, representatives from the District Hospital, NCMCH2, and Darkhan participated in a basic/introductory and refresher course. In coordination with the head of radiology, the approximately 15 course participants received an additional overview of lung ultrasound from CW.
A training course for 2 new screeners and a refresher course for the current screener took place on August 29 and 30, 2024, at Mandalgobi Hospital in the Dundgobi District.
On September 2, 2024, a refresher course for the screeners took place at NCMCH3 with approximately 10 participants.
An improvement in the structures for certification, refresher courses, and instructor status is necessary! The hip commission must gain such competencies, and the implementation of long-defined concepts must occur to prevent abuses: training by non-qualified individuals for payment, abusive practices by private clinics, etc. Time and again: the pathophysiological foundations are poor to nonexistent…
5. Official Matters
- Signing of a Memorandum of Understanding (MoU) with the management of NCMCH2 for collaboration over the next 3 years on August 26, 2024, during a formal reception.
- Meeting with UB Health Center on September 3, 2024: Reception by the English-speaking director, Dr. Erkhembulgan, who was partially trained in Germany. Positive!
- Meeting with the ADB working group, established for the coordination and implementation of screening programs: canceled at short notice.
- Meeting with the WHO delegation: canceled.
- Meeting with the Ministry of Health on September 2, 2024: Reception by Dr. Ganchimeg (Head of National Medical Service, pediatric orthopedic surgeon, formerly TC) and Dr. (Head of Quality Management and Prevention). We will see…
- Meeting with the Deputy Director of Songinokhairkhan District Hospital on August 26, 2024.
6. Consultation Hours
Presumably also for logistical reasons and due to a lack of permission from the management of NCMCH1, there were only very limited patient contacts this year. Patient contacts: 4 children were examined at NCMCH2.
7. Collaboration with Orthopedists
Meeting with Dr. Boldbaatar, who now heads the Department of Pediatric Orthopedics at TC and has apparently replaced last year’s delegation. Despite a friendly reception, there remain slight doubts about his good intentions, as he was very critical of SMOPP in previous years. The collaboration started last year with the orthopedic specialists in London is considered beneficial, and its continuation is highly welcomed. The exchange addresses all possible issues in pediatric orthopedics, with DDH being only a small part of it. A second trauma center has become active at the university. Interest in collaboration with SMOPP has been expressed from that side.
8. HipScreen
After the software did not function on a national server, it is now operational on a private basis and seems to be active again. Unfortunately, the upload has dramatically decreased in recent years due to the constant turnover among the screeners, high workload, and the significant effort required for uploading, resulting in limited control options. However, a screening rate of over 80% remains consistently confirmed.
9. Hip Commission
It is now staffed, and 2 meetings have taken place. Contrary to the agreement in 2022, we were not provided with the minutes. Apparently, it currently lacks decision-making or enforcement power because it has not been officially approved. We have insisted on this, among other things, to the representatives of the Ministry of Health.
10. Studies
- Follow-up: The radiographic examinations of 1,000 children have been completed with great effort. The workload of measurement and evaluation now falls on the radiologists and the CH study management. Tulgaa will be available for data analysis.
- Group B: A template from Stefan has been approved; the project is to be pursued. Tulgaa is drafting a specific proposal and is taking care of the approval.
- An analysis of the surgery numbers (open reductions?) is being conducted by BM and TU and is to be published.
- A comprehensive overview of the project suggested by Stefan has not yet been discussed; we initially propose an internal discussion within the CH group.
11. Strategic Planning
A meeting with the two project coordinators, BM and TU, has taken place. Here are the relevant decisions and aspects.
- Tax exemption for the import of materials must be demanded unconditionally; a position paper on this should be drafted (CW). Equipment will only be delivered once this is in place.
- Request an order from the Ministry of Health regarding the Hip Commission to secure its autonomy and regulate its competencies.
- Consequences of implementing the training and qualification concept (BM, TU).
- Promote fundamental understanding of pathophysiology (TU).
- Revision of the ABCD Manual (RS).
- Develop a timeline with a concrete strategic plan for international collaboration within SMOPP for the upcoming months and years by BM and TU.
- Hiring an assistant for TU to implement the project goals (BM, TU). The interview with a former team member of BM has taken place, and an updated CV and a cover letter are to follow.
RS and CW
