Ulaan burhan, lit. "red god", translates to measles. Not to be confused with tsagaan (white) burhan, which is smallpox. I've been in the habit of using the Russian word kori for measles with health professionals in the countryside, but learned that herders always use ulaan burhan. About six weeks ago, I first heard of the nationwide measles immunization campaign from a colleague who works at the aimag health department in Uvurhangai. Between 1-10 October, the plan was to immunize every single 2-10 year old Monolian child with an attenuated measles vaccine known as Rouvax (Sanofi Pasteur, see photo above). In addition all 2-5 year old children would be given their biannual dose of Vitamin A. This program was supported by the Western Pacific Regional Office of the WHO ("Let's Prevent Measles", Ministry of Health website, in Mongolian).
During the tail end of the campaign, I arrived in Suhbaatar aimag for fieldwork with 4 bagiin emch. I was able to observe related activities and to discuss the campaign with hospital workers, bagiin emch, and herders from all 4 sums that I visited in October. Photo right shows the advertisement for the vaccine campaign next to the front door of one sum hospital. Photo below left shows a vaccinator removing the vaccines from the refrigerator. Compared to other aimags where I've worked, Suhbaatar has a very high percentage of sums connected to the grid.
One complaint I heard every single place I went to was the lack of money that had been allocated for benzin (petrol). As I was told by physicians, drivers, and vaccinators, each sum was given 100,000 MNT (US$85) irrespective of size or population. Mongolia tends to have very high coverage for primary education. This means that countryside children live in the sum center during the school year, typically with relatives or in the school dormitory. In some cases, the parents themselves will move close to the sum center for their children's schooling. This makes vaccinating the school-age children during this time of year relatively easy, since they are all in one place. The challenge is vaccinating the young children who live in the countryside. In one sum, the hospital staff traveled 956km in the countryside, using roughly 200L of benzin, almost double what they could purchase with 100,000 MNT. Compounding the problem, benzin prices went up twice in October,
to nearly 1000MNT/L. But as a pediatrician from another sum explained to me, "It doesn't matter. It's our duty to make sure our kids get these vaccines."
It's been a very tough year for grass in Suhbaatar, aside from some sums in the south. The result is that people have been going on otor. Here's D. Altangerel's (2001) definition:
отор the pasturing of livestock in groups seeking good pasture away from the regular pasture;
In short, people break their pasturing routine because they're aren't enough resources where they typically graze their animals. And it only happens when conditions are bad. This year, people in Suhbaatar are traveling as far as 200-300km away from their home territory. Typical seasonal migrations might take people 10 or 20 or 30km. In some of these cases, herders are going to sums in entirely different aimags: Bayanhutag and Bayan-Ovoo in Hentii, Hulunbuir in Dornod, Erdenetsagaan within Suhbaatar. This obviously poses challenges to providing health services, not just administering vaccines.
The day that I left the 4th sum I worked in, some ten days after the formal end of the vaccine campaign, the hospital director, driver, and baga emch drove 130km to the north, to another sum, to track down 5 households for the measles vaccine. Those 5 households represent roughly 20-25 people out of an entire sum population of 4000.
The sums receiving children on otor were sometimes asked to find and vaccinate those children. Communication was typically from holboo to holboo (central telephone office to central telephone office), which necessarily involves intermediaries. In one case, a professional seminar at the aimag center allowed for a face-to-face request from one sum doctor to another. The sums I worked at only had people leaving, not arriving. The one exception was two children from Ulaanbaatar who were visiting and were vaccinated. Permanent marker on the pinky nail for verification.
A sum health statistician found me late one night at the hospital after he had a little bit to drink. "Why are you making us give our kids this vaccine? I've worked here for 35 years and I've never seen a single case of measles." After explaining that I wasn't the one responsible for the vaccines, I referred him to his own aimag health department. I suppose this would be the better answer: 26 cases last year after 3 years without a single case.
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