Making House Calls to Mongolia’s Herders

Shurentsetseg Ganbold is a health worker in Mongolia whose job involves an unusual amount of travel. She serves the Dukhas, a community of semi-nomadic reindeer herders in a remote part of the north, who follow their herd wherever they roam.

And wherever the herders settle for the season, Ms. Shurentsetseg has to find them, too, sometimes on horseback, along forest paths in East Taiga.

She makes house calls to respond to emergencies, treat minor illnesses and vaccinate children. Her patients call her Dr. Shuree.

On one visit, she checked a pregnant woman’s vitals and used a midwife’s harness to weigh a baby. Blood pressure medication and vitamin A drops are always in her medicine bag, because the nomadic diet is often low in vegetables and high in fatty staples like yak or reindeer milk.

Community health workers like Ms. Shurentsetseg are the backbone of the health system in Mongolia, one of the most sparsely populated countries in the world. They travel great distances to provide basic health services to people like the nomads who live far from city clinics and hospitals.

Her commute changes according to the season. In the fall and winter, the herders settle in houses closer to towns and cities so that their children can go to school. But in the other seasons, they follow the reindeer to more remote patches of land.

For Ms. Shurentsetseg, getting to them can mean traveling for hours across country roads in mud or sleet. She sometimes asks her husband to take her on his motorcycle, especially if road conditions are bad. Otherwise, she rides on her own, or drives the family car.

Ms. Shurentsetseg is the mother of three young children, ages 1, 7 and 12. She feeds her son a home-cooked breakfast and combs her daughter’s hair before setting off for work.

“My husband sometimes says that I should quit my job, especially when I need to go during the night, or during a snowstorm, or when the kids are sick,” she said. “He complains that I prioritize patients over my own children.”

But he would take her as long as he was around, she said, no matter the hour or condition of the roads.

Reindeer herders live so far from country roads that she sometimes has to rent horses to reach them. When no horses are available, she rides a reindeer to get from one tepee-like tent, called an ortz, to another.

Growing up in a nomadic family, she had taught herself how to ride a horse at age 5. These days, riding to patients both calms and energizes her.

“My spirit is lifted,” she said.

The house calls sometimes require her to get creative. When measuring babies, Mongolian doctors are taught to place them against a wall. But in a tepee-style tent, she lays babies on the ground instead.

She works closely with a doctor in a district hospital, and part of her job is knowing when to nudge the herders to seek help at a higher level. When a patient described a months-long toothache, Dr. Shuree gave her some antibiotics and urged her to see a dentist in town.

Rural health workers like Ms. Shurentsetseg are known for working at the “bagh” level, the smallest administrative unit in Mongolia, a country that is double the size of Texas, but with a population of just 3.5 million. The workers are credited with helping the country expand immunization and lower maternal mortality rates.

Ms. Shurentsetseg is one of only two such workers who goes to reindeer herders at their camps in Tsagaan Nuur, a northwestern region of 1,400 people. When she visited them in the spring in East Taiga, there were 20 families.

When she’s on the road, she worries about getting lost or running into wolves and bears. The harsh terrain also brings the risk of floods or of falling through ice. And she can never be sure if the horses she rents might get spooked and throw her.

Her biggest fear, though, is not reaching her patients in time during an emergency.

But she finds strength in the elements around her. “I believe in the spirits of the mountain, river and water,” she said. “The spirits are watching me. I believe that they are with me.”