1 00:00:00,000 --> 00:00:20,000 Mongolia. It is a starkly beautiful country with a rich history. But when Soviet subsidies ended in the early 90s, Mongolia's health care system crumbled, putting hundreds of thousands of its citizens at risk. How is Mongolia dealing with the challenge? Here's our story. 2 00:00:20,000 --> 00:00:37,000 Mongolia, Central Asia. It is mid-February. The temperature is minus 30 degrees Celsius. 3 00:00:37,000 --> 00:00:57,000 My name is Ulzi Jagal. I live in the northern district of Kenti province in Mongolia. 4 00:00:57,000 --> 00:01:02,000 Ulzi Jagal is about to give birth to her second child. 5 00:01:02,000 --> 00:01:08,000 I'm nine months pregnant. I'll give birth any time now. 6 00:01:08,000 --> 00:01:34,000 But pregnancy is hazardous. According to the World Health Organization, every minute of every hour of every day, a woman dies as a result of childbirth. Ulzi Jagal is not immune to this threat. Mongolia's harsh climate and recent turbulent history means that she and her unborn child could be in real danger. 7 00:01:34,000 --> 00:01:51,000 Despite the timelessness of the landscape, Mongolia has in fact changed dramatically over the last 80 years. 8 00:01:51,000 --> 00:02:12,000 As a de facto Soviet colony, Mongolia was radically transformed from a nomadic society into an industrialized, urbanized one. Heavy subsidies from the northern neighbor meant that suddenly the Mongolians had a socialized state with nationwide education and health care. 9 00:02:12,000 --> 00:02:34,000 Hospitals and clinics were built in the furthest parts of the country, and free medicines and health care were taken for granted. Mongolians never had it so good. So in the 1990s, when the Soviets abruptly departed, taking their huge subsidies with them, the whole country was shaken to the core. 10 00:02:34,000 --> 00:02:43,000 My name is Dr. Khlauga. I'm the senior doctor here at Henti District Hospital. I've given the last 22 years of my life to this place. 11 00:02:43,000 --> 00:03:05,000 When the Soviet subsidies ran out, the Mongolian health service was decimated. The worst hit were the provincial hospitals like Dr. Khlauga's in the poorest rural districts. After many years working under a socialist system, they've been suddenly forced, unprepared and underfunded, into a free market. 12 00:03:06,000 --> 00:03:20,000 Under the socialists, we would receive medicines where they were needed, whenever they were asked for. But after the transition, the government stopped delivering. Suddenly, we were without even the essential drugs. 13 00:03:21,000 --> 00:03:38,000 The cuts also meant that many wards and facilities were forced to close. All across the country, it was the same, as hospitals and clinics had to come to terms with a new austerity. For doctors, this was hard to stomach. 14 00:03:39,000 --> 00:03:58,000 I felt inside me an anger, a real anger. Just how were we meant to provide a health service for our people under these conditions? This fellow, that guy, him, her, all these doctors left our hospital and went off to the big cities like Ulaanbaatar. 15 00:03:59,000 --> 00:04:09,000 But while Dr. Khlauga was able to do what he could for the patients in the town, his ability to help those in outlying areas was increasingly limited. 16 00:04:10,000 --> 00:04:34,000 In the good days, we had ten ambulances available. With these, we could reach the whole province if necessary. But our fleet was decimated in the 90s. There was no petrol. There were no spare parts. By the end, we had just two vehicles suitable for long-distance journeys. This, of course, made doing our job doubly difficult. 17 00:04:35,000 --> 00:04:40,000 We couldn't even get to many of the pregnant women in time to help them. 18 00:04:41,000 --> 00:05:02,000 When a health system collapses, the people who are hurt the most are the rural poor. People like Wulzi Jagal and Baturu. Their homestead is at least a day's ride from even the most basic medical facilities. 19 00:05:03,000 --> 00:05:11,000 Rural nurses are in the vanguard of maternal health care in Mongolia. 20 00:05:12,000 --> 00:05:35,000 I look after 100 households spread throughout a 100-kilometer-wide district. I must travel regularly to see my patients, especially for auntie or postnatal visits. Unfortunately for me, the homesteads are very spread out. Sometimes I must ride 50 or 60 kilometers to reach the women in need. 21 00:05:35,000 --> 00:05:45,000 Rural nurses are one of the first beneficiaries of the Mongolian government's new commitment to maternal health care. 22 00:05:45,000 --> 00:06:00,000 Since 2001, with help from the World Health Organization, Mongolia has introduced a no-child-left-behind policy, an acknowledgement that the health system had been failing abysmally. 23 00:06:01,000 --> 00:06:08,000 Government expenditure now includes investment in the once-neglected health care system. 24 00:06:08,000 --> 00:06:21,000 The new policy provides for additional medicine and emergency vehicles to hospitals, health clinics, and for rural nurses like Cukcuk. 25 00:06:22,000 --> 00:06:28,000 Today, Cukcuk is making an antenatal visit to expectant mother Ulzi Jago. 26 00:06:41,000 --> 00:06:48,000 Cukcuk decides that Ulzi could give birth at any time. It is not safe for her to remain at home. 27 00:06:51,000 --> 00:06:58,000 The revived health system now makes it possible for Cukcuk to call for help to get her patient to a clinic. 28 00:06:58,000 --> 00:07:21,000 For Ulzi Jago and thousands of women who live in rural areas of Mongolia, the journey to motherhood is no longer as hazardous or treacherous, but as enriching as the Mongolian landscape.