What are we paying for?

Out in the cold on a Sat night

[This anecdote is from last week.] Our son was sick last evening and through the night--unable to keep any food down. This morning, while I was washing my hair at 6 am, a Doctor arrived to our apartment. He took Enji's temperature, examined his throat, pushed and poked around his abdomen (ruling out an appendicitis--Zorig's fear). This was what we'd call a "house call" in America--something that existed back in the 1700 and 1800s--but unheard of in these modern times. I asked Zorig how he got a doctor to come at 6 am. He said he called the "emergency number." This is the same number you'd call if you needed an ambulance. Apparently it can be used for house calls! Zorig called around 5:30 am; the doctor arrived shortly after 6.  Curious, I asked, "what does that cost?" The answer--nothing! As a Westerner, I was baffled by this reality. 

My guess is that this is a remnant of the socialist/communist time period in Mongolia (from the 1920s to 1990 when Russia withdrew). As an American, we are groomed to believe that you get what you pay for. Paying nothing for a doctor's opinion, in your home, at 6 am....is hard to comprehend. While I know there are many issues with Mongolian healthcare and I have numerous friends and colleagues that have shared horror stories with me, I am yet amazed by what happened. Enji was sick with a 24 hour bug and returned to school the next day.

This is just one example of a few I'd like to discuss. Before moving to Mongolia I had never lived abroad--within another culture/country/way of life.  While I had been deployed with the U.S. military, there was always our own healthcare options available. But here in Mongola, I am simply an expat living abroad and using the options available to me. 

My Chiropractor's sign

Here are some examples of what I have experienced (yes, some are a bit specific/personal). Keep in mind that I have NO health insurance (I know....OH THE HORROR...but honestly, I find it freeing!) and pay for everything out-of-pocket:

• I visited Intermed (hospital where many foreigners and well-off Mongolians seek treatment) for a pelvic exam (something women do periodically). I paid just $17.00 for the exam and a urine lab test.
  **NOTE: To schedule an exam or appointment of any sort--you pay 35,000 Tugrik. (When I first got here that equalled about $17.50, with the tugrik value dropping, it's now $14 or less).
• I visited a chiropractor (Mongolian man who trained in the U.S.) and paid $10 for a one-hour spine focused massage followed by an adjustment. Kicker--after four visits he told me that my "treatment was finished" and I didn't need to come anymore. Now WHAT chiropractor in the U.S. would ever say something like that? In the U.S. I paid $32.50 for ONLY an adjustment and that was IF I went every other week--aka--was on a plan[A sidenote here: In the U.S. I started going to a chiropractor when I was 35 years old. I continued to go on "maintenance" until I left. I went at least once or more often twice a month. AND I STILL HAD ISSUES!!! I lived in Mongolia for 16 months before I HAD to visit a chiropractor. I'm thinking the hard beds and more minimalist way of life are GOOD for the human body--all the cushy stuff we use in the U.S. to make our lives "nice"....might actually be doing us physical damage AND costing us MORE money.]
• I went to Intermed to see the dentist for a cleaning. I paid the 35,000 for my appointment and an additional 102,000 for the cleaning. Grand total: about $62. Oh.....and did I mention that the entire cleaning was completed with an Ultrasonic. While hand-held scalers (aka scrapers can be as effective--it takes WAY longer). You can read here about the Pros and Cons of both. In the US I paid for well over an hour of cleaning--most of it scraping--while here it was about 30 minutes and cost WAY less--while using an electronic tool. I don't know about you....but I prefer the Ultrasonic. In the U.S., hygienists would ONLY use the Ultrasonic for the backside of my bottom front teeth (where coffee stains build up). I prefer the service and approach I received here. Granted....I don't have dental insurance to "cover" my twice annual cleanings....but at $62, I'm okay with the option. In the U.S. that dental "EOB" would show that my "cleaning" costs well over $200-300, I suspect. And that's WITH the wonky math about being "in network" or "out of network" etc.
• I choose to go to a Laser Emneleg (hospital) to have some dark spots on my face "lasered." I paid $75 for two visits--the first to laser the spots (from forehead, down my face, and including my neck) and the second to do a skin peel and cooling milk mask. I wouldn't call myself an especially vain person--but I could NEVER afford such a treatment in the U.S. The doctor wanted to inject something to lighten a couple of spots and I declined. BUT....I may go back for that.   

Many of my colleagues have health insurance as they are "foreign hires" whereas I'm a "local hire." Many of them will NEVER reach their deductible ($200, I believe) to be able to use their insurance benefits. Granted...IF you have a serious incident--for example need to have your gall bladder removed--then YES, you would use your benefits. But for the average, every day kinds of issues--paying out of pocket is completely affordable. Almost CHEAP. 

Pic taken from my front-seat bus-ride home

I've heard that having a baby here costs about $1,000. If you want a completely private and pampered experience--at most $5,000. What does that cost in the U.S? (I have no idea!)

Now....I will add that for foreigners there can be a great distrust of some of the medical advice one receives here in Mongolia. Beliefs about health and wellness can be vastly different. As a general rule, I don't find that Mongolians have as much education as Americans do around the science behind sickness (and the diet is still lacking--not nearly enough vegetables and far too much wheat and oil); additionally, there is great value placed in superstition or what we might call old wives tales, as well as great stock in traditional medicine practices. I'm NOT against traditional medicine as a concept. However, I don't believe that spending a week to ten days in the hospital for "treatment" which includes a series of injections seems at all necessary. Especially when it's just scheduled like a week at the spa or resort. Nor do I think a sinus infection requires surgery--but have been told as much by my own husband. I believe that generally the body will heal itself with responsible self-care--extra sleep, lots of fluids, and increased Vitamin C (I do love the seabuckthorn juice here!). Most Mongolians I know seem to run off to the hospital at the first inkling of an illness. I ONLY go to the hospital if it's an emergency OR I've been fighting something for 10 days to two weeks. 

As Americans experience--a stay in the hospital is EXPENSIVE. Shoot....when I had my emergency gall bladder surgery in 2014 I spent a full week in the hospital and the surgery included an epidural for post-surgery pain management.  My entire bill was over $56,000!!!!! I paid my maximum out-of-pocket which was $6,000. Here in Mongolia, at a hospital that treats expats, an individual having a similar experience--six nights in the hospital and gall bladder removal--the bill just over 5.7M Tugrik which converts to about $2,380. 

All of these examples--but ESPECIALLY THIS LAST ONE--make me wonder, what in the hell are we paying for in America? Like really....what the heck is going on? Before I moved here MANY people asked me about health insurance. Would I have it? What was the coverage? Where would I get treated? Honestly, I don't miss a damn one of those EOB statements that showed me BULLSHIT math. I love that I can pay out-of-pocket and get decent care. Now I realize that if I were in a terrible accident, I might feel differently. I can't say I'm impressed with what I've seen here in the form of rehabilitation after major surgeries. And Mongolians that CAN go abroad (mostly Korea) for treatment, DO. That is telling. There is NO perfect system....but I can say that I don't miss the American system AT ALL. And I seriously wonder what we are all paying for (perhaps all the malpractice insurance that doctors have?). 

As the CDC reports here (from January), more than 750,000 American travel abroad for what is termed "medical tourism." More recently it was reported in The Fiscal Times that approximately 1.4M Americans will go abroad this year seeking medical treatment because it's TOO EXPENSIVE in their OWN country. The article says a handful of American insurance companies would rather pay travel and treatment expenses abroad, than within their own borders.

So really....what the heck is going on in America? I *cringe* at the thought of ever having to return to a healthcare system that seems SO outrageous. 

Choose Your Own Journey

Zorig and me at the ASU Gala

I love the work I do with teenagers--teaching them how to find, evaluate, and use information, sharing my passion for learning, hearing their fears and worries around paper writing and project construction as well as their hopes and dreams for the future. Yes, I love being a part of their becoming, so to speak. I also enjoy supporting fellow educators-- expanding their content assignments with research components, introducing new or better resources and/or online tools and applications, partnering with them to push our students to think critically and to cite their sources--making all of us ethical users of information. Yes, this whole Library and Information Science thing is exactly what I should be doing. And yet, as I left a colleague's classroom this past week, after giving demonstration and instruction around EBSCOHost databases, how to effectively search Google, and how to use EasyBib, I shook my head and smiled, all the while thinking to myself--"How in the world did I end up here?" 

You see, being a teacher OR a librarian was NEVER on my radar. Looking back at my High School yearbook, I proclaimed I wanted to go into International Business and Foreign Languages. Documents I completed while attending my Army Basic Training talk about wanting to pursue a degree in Criminal Justice. As I worked my way through my undergraduate degree, I had a variety of declared majors. I went from Undecided to Secondary Education-History to Business (WHAT?!?) and finally landed as an English major. 

One of the students in that colleague's classroom last week asked me how I chose my major. I tried to explain my circuitous route. The Secondary Ed History major was declared because I had some elective history courses (Colonial Africa, Latin American history) that I LOVED. So, I declared myself a history major. But then I was pushed to answer the question--WHAT JOB WOULD/COULD I get with that? Teaching seemed to be the ONLY option and far too limiting. 

With colleagues at the Gala

Then I thought only about jobs that might provide a good income. I moved from PA to ID and changed my major to Business. Then I took a required Math class and realized that while I was good with general math, even algebra or geometry, it really was NOT something I had a natural aptitude for and certainly NO passion for. At that juncture I finally had a heart-to-heart with myself. What was it that I LOVED TO DO? What was I passionate about? What did I like to learn about?

I loved to read. I loved to write. I loved to put the two together. Being an English Major became the obvious forerunner. As I discussed the change with people, that annoying question came back to the surface, "but what kind of job can you get with that as a major--besides teacher?" I didn't really have an answer. Being a teacher WAS still NOT something I considered. But I knew that if I was going to go into financial debt to pay for college--I wanted to enjoy the education I was getting. And it also became clear around this time that degrees weren't always tied to the work one does. My supervisor at the time (working at Hewlett Packard) was a personnel manager. His undergraduate degree was from Purdue in Architecture. So I got my BA in English and loved every minute of it. 

Then I floundered for a couple of years. I had a good paying job with solid benefits at Hewlett Packard and wasn't motivated to seek something other than. But one can only answer phones in a call center for so long. After dealing with a difficult customer one afternoon, I thought to myself, "I cannot do this for the rest of my life. I want work that means more. I want to make a difference." Long story short--I discovered the world of Library Science and had my Master's degree in about 20 months. I loved the course work. Initially I thought I'd be a public librarian. I loved my public library (PPLD of Colorado Springs)! 

At the Marine Ball

Then another "aha moment" hit me when I considered answering the question: "If you had all the money in the world, what you do?" My answer--I would be a perpetual college student--getting degree after degree. I love to learn. I love to open a brand new notebook, use colored pens, take notes, write papers, read. Yes, being a student is what I most loved being in the world. So I wondered--maybe if I was a librarian in a school--where learning was happening all around me--I could feed the student in me while also making a dependable income. I absolutely made the right choice! I love what I do--while teaching others (both students and adults) I learn so much myself. 

All this to say.....life is sometimes not what you expect or envision. Sometimes you don't know where you belong, until you pause, look around, and marvel at the synchronicity of your being in a time and place, doing what you're doing. This does make it challenging to give youth solid advice. Some may chart an immediate and direct course and never waver; others, like myself, may find themselves in and out of the fast lane and sometimes taking detours on dirt roads. Some may end up where there are no roads at all. No matter where you go, or how you get there.....the journey is your's to determine. My small offering of advice--YOU choose it (not anyone else!), feel free to make u-turns or change direction, and it's perfectly okay to stop and enjoy the scenery and people along the way. One never knows how a place, or person, or interaction may forever alter the path. That's the beauty of it all. And if you aren't happy--you have no one to hold responsible except yourself. Get moving and Journey on! 

It's the Freedom I Love Best

I hate to say it aloud...but winter has arrived to Ulaanbaatar. On the Celsius scale we have sunk into the negatives and I expect we'll be there until after Tsagaan Sar (end of February this next year). While it snowed first in September, we've had a number of dustings in October. Here's a snapshot of Enji and I on the morning of October 5th as we departed to catch our school bus (which picks up just 50 yards from our apartment door--so nice!) 

The days are getting shorter and we will soon leave for school in the dark and return just as night descends. While the darkness drives me to *want* to be inside, it doesn't much affect Mongolians. When I look out our kitchen window and down onto the pedestrian plaza underneath it, it is always busy with people--adults and children--going this way and that. They are bundled up in their knee length coats, scarves, and hats. There are yet peddlers on the street. Example--the selling of pine nuts. I can't imagine the work of harvesting these little nuggets, but they are for sale everywhere. 

Pine nuts for sale on the plaza

And as Zorig tells me, ALL Mongols eat these. I have tried them, and I like them, but I am not adept at splitting open the little shells. Even with lots of practice. Zorig will buy a a little plastic bag holding about 4-5 cups of them for about 5,000 MNT, or maybe a little more. That's hardly more than $2. I'm beginning to think he's correct--I've observed pedestrians chewing away at them, watched drivers and passengers in vehicles chuck the shells out their window, AND while riding the public bus I've found the sliding window sills insulated with the empty husks. Yep, samar (mongolian word for nuts) are a popular pass time in Mongolia.

I was all alone for a couple stops

This past week we had book club (we read Miss Peregrine's Home for Peculiar Children. I felt "meh" about the book, but thoroughly enjoyed our discussions!). This time last year I felt uncomfortable walking and riding the bus around at night. I wanted to get home asap. While the cold can drive a person to do that, I am a year older and specifically, a year older at living in Mongolia. It WAS cold on Thursday night when I left the Teacher Apartments at ASU and hoofed it to the bus stop. But there were also less people out and about making it feel uch later than it was (only 8:30 PM). I hailed the bus driver of a number 55 bus....I don't think he planned to stop. But he did a rolling-door-open for me and I hopped on. I was the only person on for most of the trip--which compelled me to take my phone out and snap pictures. I NEVER do that anymore because it can make one a target for pick-pockets. My phone is on silent and tucked away for any and all bus rides--well except this one. :) 

One other passenger, going over Peace Bridge

I opted to ride the 55 a little farther to see which route it took past the Nomin San (Central library) stop. This led to me walking farther than planned--but now I know. It was a cold night...but there were lots of people out and about. In fact, when I arrived to the pedestrian plaza near home, there were a number of teens skateboarding around the Beatles Statue. I checked the weather when I got inside--it was a 16 F outside. I tried to think--would an American teenager be skateboarding in sub-freezing weather? I want to say "no"....but I'm not sure. Teens can be unpredictable. However, I'd certainly say that Mongolian teens are acclimated for this weather. 

As I rode that bus and walked home in the cold night air, I felt free and elated. I tried to think about how that compared to life in America--to discern what I like about living here the most. And just a couple days before Enji said to me:  "I have a question for you. And be totally honest! Have you ever regretted moving here?" 

"No. Never," I said emphatically, and smiled. There was NO hesitation or pause. It is the truth.

And yet, I know life here can frustrate me. And sometimes I pretend to imagine what it would be like if I returned to live in the U.S. When I do that, I realize all the things I would miss about living abroad, living in Mongolia. I would miss:

• making way less but saving way more (incredible financial freedom--something I never experienced while living in the States); 
• the incredible freedom of using public transportation (I LOVE that I ride a public bus and do not have stress around driving. Not to mention the cost!); 
• the relative inexpensiveness of things: I cringe at the COST of everything in America; 
• my free and in-the-moment shifting calendar of plans. I do not miss my overbooked schedule (in the US I often knew what I was doing weeks and months ahead of time) and LOVE the spontaneity that IS a way of life in Mongolia; 
• the wide open expanses of land. Living in a country that is nearly fence-free does something to one's spirit that is difficult to put into words;
• living in a culture where i perceive there is far less judgement and criticism--I experience it very much as a live-and-let-live experience. Again....it's a different experience of FREEDOM. We talk a lot in the U.S. about how we are free country and we support many personal freedoms. However, I'd argue we cage and box ourselves in. I know freedom far more personally here.;
• the way children can be found anywhere and are allowed to just be. Children run around restaurants and play with other children; parents aren't always confining them and making them be still. And no one is bothered--there is a collective "watching" that takes place. Also, the way older children watch after and genuinely ENJOY being with younger children. Mongolia does this really well!;
• The directness of people saying what they want and need. Some perceive this as rude, I find it refreshing!!

There are, I'm sure, many other things. Us American Wives have been discussing this topic recently on our group page. With most raising children in mixed-culture homes there is always the question of how to hold traditions of both cultures. And how to do that when the can seem so very different from one another. I can see it in my discussions with Enji. He has only seen and known the Mongolian way of life; I try to share with him a Western approach. I am not trying to say one is better; but he will have some choices in his life and will perhaps want, in some cases, to make a more Western-like choice. That's the think with teens-becoming-adults--you can give them advice and suggestions and try to show and tell them what you think is best. But in the end, they are creating their own life and have to make their own path. 

I'll stop here with my musings. I have a weekend getaway to finish packing for. It will be my last trek outside the city for a number of months. I'll  leave you with a question to reflect on....or post your thoughts on: What do you love best about American culture or society (Or your home culture, if by chance you are not one my American friends or family members)?  If someone came to live in your country from somewhere else, what would you hope or wish for them to appreciate or feel the most?