L.Ganchimeg, a dedicated nurse from the “Amin Tus” Family Hospital in Khan-Uul District, was recently honored as the first recipient of the award for Best Nurse in Palliative Care and Services at Primary Health Care Institutions in the capital city. We had the opportunity to speak with her about this significant achievement and her work in the field.
The Best Palliative Care Nurse competition concluded at the end of last month, and we would like to extend our heartfelt congratulations to you on being named the top nurse.
Thank you. In the final round of the competition, the top 15 nurses from various districts participated, including four representatives from our hospital. This was the first time such a competition focusing on palliative care and services had been organized in the capital, which made the experience both exciting and nerve-wracking. We were all eagerly anticipating the results. I’m proud to share that nurses from the Khan-Uul District Health Center secured first, third and fourth places. It was a proud moment for us, especially as another nurse from our hospital achieved fourth place. Our success is a great reflection of the dedication and quality of care provided by our team.
I understand that you have been working at the “Amin Tus” Family Health Center for over 10 years. Did you begin your career there?
I began my medical journey by graduating as a junior doctor from the School of Nursing at the Mongolian National University of Medical Sciences in 2013. In 2020, I furthered my education and earned a nursing degree from the School of Nursing at Global Leader University, and I currently hold a senior nursing qualification. My professional career started at the Pediatric Resuscitation Department of the Second Children’s Hospital in Sukhbaatar District. For the past 11 years, I have been working as a nurse at the “Amin Tus” Family Hospital in the 10th khoroo of Khan-Uul District.
Why did you choose nursing as your profession? It’s a field that comes with many emotional challenges. Have there been moments when you felt discouraged, and how did you overcome them?
My decision to pursue a career in nursing was deeply influenced by my family. Although I had no healthcare professionals around me growing up, I was inspired by the simple wish to be able to give my loved ones a single injection when they were unwell. As I began working in the field, I gradually came to understand the true depth of the nursing profession, it is a calling to care for those who are suffering physically and emotionally. Nurses are often the closest point of contact for patients, and over time, many of them came to feel like family to me. I found myself genuinely concerned about their well-being even after work hours. While there were certainly challenges, such as dealing with difficult patients and emotionally taxing situations, I was encouraged far more often than discouraged. I encountered many patients who were kind, respectful, appreciative and cooperative, which reminded me of the value of my work. Being part of a supportive and cohesive team also played a crucial role in helping me overcome obstacles and continue growing in my profession.
A total of 726 nurses from over 150 family health centers participated in the Best Palliative Care Nurse competition, and only 15 advanced to the final round. That sounds highly competitive. What was the task in the final round, and how did you prepare for it?
The competition was jointly organized by the Ulaanbaatar Health Department, the Mongolian Palliative Care Association, and the Department of Nursing at the Mongolian National University. It brought together nurses from primary health care institutions across the capital. The first two stages of the competition took place on May 24 and 25 and consisted of online knowledge-based assessments. A total of 53 nurses advanced to the second stage. The final round focused on practical skills and required participants to provide personal care to clients in simulated scenarios. The top 15 nurses were randomly assigned cases through a lottery system, ensuring that no two participants had the same case. Each nurse was evaluated by a panel of three judges, and in addition to the assigned tasks, they were asked supplementary questions to further assess their competence. The final tasks centered on delivering care to patients with incurable illnesses, focusing on relieving pain and suffering - situations that closely reflect real-life challenges in palliative care.
It was noted that the final stage of the competition did not involve an online knowledge test, but rather focused on providing in-person care and services. Could you explain in detail what the participants were required to do during this stage?
In the final round, the assigned case involved a patient in the advanced stages of cancer, also suffering from liver cirrhosis. The patient was bedridden, severely ill, experiencing significant symptoms such as hair loss and intense headaches, and unable to perform even basic self-care. The head of the bed was positioned against the wall, and due to the patient’s condition, there was no access to a standard wash basin. The task was to demonstrate how to hygienically wash specific parts of the patient’s body, specifically the head, face and chest, using only materials commonly found at home. The goal was to perform the procedure in the correct order, following proper standards, while minimizing the patient’s movement and ensuring no additional pain or discomfort. Participants were asked to perform the procedure on a training dummy, simulating real-life conditions, and were instructed to engage with the “patient” by speaking to them, acknowledging their pain and demonstrating empathy. Judges closely observed the entire process, evaluating both technical skill and the quality of interaction with the patient. Additional questions were asked to assess the nurse’s depth of knowledge and practical decision-making.
Palliative care aims to relieve pain and suffering while enhancing the quality of life for patients with terminal illnesses. How do family health centers deliver this type of care at the community level?
The Family Health Center delivers palliative care and services in alignment with national standards, including MNS 5292, MNS 4621 and MNS 5455-1, as well as the Ministry of Health’s Order No. A/329 (2015) and Order No. A/182 (2019). Our center provides home-based palliative care for patients with terminal illnesses, those with irreversible conditions, individuals with a clear prognosis and patients requiring post-operative home care and nursing. In addition to direct care, we offer comprehensive support to family members and caregivers by providing training, guidance, and recommendations on essential aspects of bedridden patient care, such as the prevention of pressure ulcers, proper feeding techniques, wound care and dressing. In essence, our services are structured around the five levels of nursing care, ensuring a holistic, compassionate, and patient-centered approach tailored to the needs of each individual and their family.
Cancer is one of the leading causes of death in our country, and palliative care becomes especially important in the later stages of the disease. Could you share how many patients your family health center serves in total, and how many of them currently require palliative care?
Mongolia currently ranks among the highest in the world for cancer-related deaths per 100,000 population. According to last year’s statistics, 8,169 new cancer cases were reported, and 4,755 individuals lost their lives to the disease. Over 30,000 people nationwide are under ongoing cancer surveillance. In fact, one in every four deaths in Mongolia is attributed to cancer. The Ministry of Health has emphasized that the rising number of cancer cases is largely linked to lifestyle and environmental risk factors such as excessive alcohol and tobacco use, air pollution, poor diet, obesity and environmental degradation. In response, there is an increased focus on strengthening the coordination of palliative care and services across all levels of the healthcare system, from primary care facilities at the khoroo level to district hospitals, provincial centers and referral institutions such as the National Cancer Center.
Our Family Health Center currently provides primary health care services to a population of 10,500. This population is categorized into five health groups. Citizens in groups four and five, those requiring palliative care, are monitored and supported based on their physical condition and the level of care available at home. Depending on their needs, patients are revisited every seven to 21 days, or at least once a month, following a rotation schedule. Currently, we are providing palliative care to 96 individuals, nine of whom are permanently hospitalized. The majority of our palliative patients are over the age of 60. When more advanced care is needed, we collaborate closely with our partner hospice hospital to ensure that patients receive the appropriate level of support and comfort.
Providing care to people nearing the end of their lives must be very challenging and emotional. How do you find the experience of communicating with patients in such difficult circumstances?
While many families show great dedication and compassion in caring for their loved ones in need of palliative care, sadly, we also encounter heartbreaking cases of neglect. During our regular home visits, we provide not only medical support but also guidance to family members and caregivers on how to properly care for the patient. However, when we return just a few days later, we sometimes find the patient alone, without food, warmth, or basic care. One of the most painful experiences was finding a patient left in a small, unheated shed in the middle of winter. She looked at us with tears in her eyes, unable to speak - a moment that still haunts me. It is deeply distressing to witness such neglect, especially from one’s own children.
These experiences have taught me that the quality of upbringing matters far more than the number of children one has. What truly defines the final years of a person’s life is not how many children they raised, but how they raised them, with love, empathy and respect. In the end, it’s not about academic degrees or material success; it’s about raising human beings who will offer warmth, a helping hand, or even just a cup of tea when it’s needed most. Family values and emotional nurturing are the true foundation of care and dignity in old age.
Do you also provide psychological care and support to patients and their families as part of your services?
When a family member becomes seriously ill, it places a significant emotional and financial burden on the entire household. The stress affects not only the patient but also their loved ones, who often struggle to cope with the situation. That’s why psychological support is essential. To address this need, we connect families with psychologists at the district health center for counseling and emotional support. Recognizing the growing demand for mental health support, our Family Health Center took proactive steps in 2020 by training two staff members as psychologist-nurses, one of whom is myself. This initiative has enabled us to provide more immediate and accessible psychological care to patients and their families. Looking ahead, there are plans for the district’s family health centers to expand this effort by training an additional 10 nurses to become qualified in psychological counseling. This will strengthen our capacity to deliver holistic, compassionate care that addresses both the physical and emotional needs of those we serve.
Being the primary care unit closest to the community, the family health center plays a crucial role in healthcare delivery. Could you share more about the specific services and responsibilities your center handles on a daily basis?
As providers of primary health care, family health centers serve individuals across all age groups, including pregnant women, children, adolescents, adults and the elderly. Their responsibilities are wide-ranging and include home visits, on-call services, outpatient care, emergency response and resuscitation services. They are trained to diagnose and test patients and, when necessary, refer them to higher-level medical facilities for further treatment. In addition to curative care, family health teams play a vital role in prevention. They regularly organize screening programs and public health campaigns aimed at early detection of diseases, often before symptoms appear. Health education is also a core component of their work, empowering citizens to take an active role in maintaining their well-being. Family medicine professionals are known for their adaptability and ability to respond flexibly to a wide variety of health care needs, making them a cornerstone of the public health system.
There is some criticism that family clinics sometimes employ doctors and nurses who may lack sufficient competence, which leads some citizens to bypass their Family Health Centers and seek care directly at secondary or tertiary hospitals. What is your perspective on this issue?
I’ve heard similar concerns, and there are indeed several contributing factors. One major issue is the instability of employment within family health centers. At one point, it was a requirement for medical professionals to complete two years of work at a family health center before pursuing a specialization. However, by the time new graduates were ready to begin working in a family hospital, those two years had already passed, reducing their incentive to join or remain in primary care. This created a significant challenge in maintaining stable and experienced human resources in family health institutions.
Another factor is the rapid increase in the number of medical schools training doctors and nurses. While the intent may be to meet workforce demand, the quality of education in some institutions has come into question. As a result, we are seeing a rise in underprepared graduates entering the field, which directly affects the quality and consistency of care provided. This is a real issue we are facing on the ground, and it highlights the need for more strategic planning in both education and workforce development.
