Mongolia; a vast, and remote nation with a cold climate. These may be some of the associations one makes when thinking about the land of the Steppes. These thoughts crossed my mind when an opportunity to volunteer in Mongolia’s capital Ulaanbaatar presented itself in early 2019. I still jumped at the chance, all the while made more exciting by the fact that the volunteering work was in the field of Radiation Oncology Medical Physics; a specialty that I had developed my career in. The purpose of the volunteering assignment was to assist Mongolia’s only oncology hospital, the National Cancer Centre of Mongolia (NCCM), in setting up new radiotherapy technology and techniques. The Mongolian colleagues I had the pleasure of working with were eager to learn new things and build upon their knowledge base to ultimately improve cancer services for the people of Mongolia. And what I found in Mongolia during my stay was beautiful landscapes and a warm people; hospitable and welcoming.
Mongolia is a country with a population of approximately 3.2 million and cancer results in about 4000 deaths per year.1 Access to modern radiotherapy is an issue that especially needs to be addressed in low and middle income countries since roughly 50% of cancer patients will need radiotherapy at some point in their treatment.2 In Mongolia the number of total high energy radiotherapy machines per million people is 0.7 which is low when compared to Australia, which has nearly 6 times more (with a ratio of 4.0).1
The Asia Pacific Special Interest Group (APSIG) of the Australasian College of Physical Scientists & Engineers in Medicine (ACPSEM) organised the assignment to Ulaanbaatar as part of ongoing support of radiotherapy in the Asia Pacific region. This assignment was scheduled to coincide with the start of preparing new radiotherapy equipment for clinical use in the treatment of cancers. It also built upon the previous work of volunteer doctors, physicists, and radiation therapists. The new equipment consisted of many therapeutic, dosimetric, and technical items; the main ones being two new multi-million dollar linear accelerator machines, which are used to deliver cancer-killing x-rays to patients. These new machines are among the latest types of radiotherapy equipment and are currently being used in all parts of the world. They will allow for faster and more effective cancer treatments, and open the door to implementing advanced treatment techniques in the future. These complex machines are the first in the country and require expertise to setup and use.
The main aim of my visit was to train the local Physicists. The training consisted of performing the commissioning tasks to prepare the linear accelerators and other equipment for use. Training also consisted of performing ongoing quality assurance tests (QA), which are used to ensure the machines are performing as expected, in a safe and efficient manner. The local staff were also trained to be the trainers of the future in order to develop a self-sustaining model of continuing education. Local physicists gained valuable knowledge and experience with regards to modern radiotherapy equipment and substantial achievements were made during my stay but ongoing support is necessary in the short term for the improvements to take hold and be built upon in the future, to ensure the care of cancer patients in Mongolia is continually improved.
The addition of the two new radiotherapy machines has greatly improved access to radiotherapy for Mongolia’s cancer patients. Introducing modern radiotherapy techniques will help improve treatment outcomes, including survival. While these improve the present situation of radiotherapy technologies and techniques available in Mongolia, other efforts introduced in conjunction, such as lifestyle modifications, vaccine implementation, and earlier screening will help to reduce overall cancer incidence in the future.
- World Health Organization Cancer Country Profiles, 2014
- Barton M B, Frommer M, Shafiq J. 2006. “Role of Radiotherapy in Cancer Control in Low-Income and Middle-Income Countries.” The Lancet Oncology 7 (7): 584–95. doi:10.1016/s1470-2045(06)70759-8.