$Unique_ID{COW02446} $Pretitle{276} $Title{Mongolia Chapter 6B. Patterns of Living and Leisure} $Subtitle{} $Author{Trevor N. Dupuy, Wendell Blanchard} $Affiliation{HQ, Department of the Army} $Subject{mongolian medical country years health hospitals even first bator mongolia} $Date{1973} $Log{Praying Ceremony*0244601.scf } Country: Mongolia Book: Mongolia, A Country Study Author: Trevor N. Dupuy, Wendell Blanchard Affiliation: HQ, Department of the Army Date: 1973 Chapter 6B. Patterns of Living and Leisure [See Praying Ceremony: In a temple. Courtesy Embassy of Mongolia, Washington DC.] Yesterday's nomadic Mongolian was, on the whole, a hard worker. He had to be, in order to support his family, even to survive personally, in the frigid winters of the Mongolian steppes. The herdsman's life, moreover, is almost by definition an arduous one with much movement and horseback riding. In the Mongolian's case, the very task of uprooting his ger and goods, moving them sometimes great distances, and then settling again was no easy effort. There have been repeated accusations that the Mongolian is lazy. The answer is to be found in the great differences between the free life of the herdsman's open steppes and the disciplined regime of the factory or office worker in today's changing Ulan Bator. Freedom of movement and work, habits geared to the season rather than to the hours of the day, were both cherished values and the actual way of life among the nomadic Mongolians of yesterday (as it still is for some of the steppes today). The Mongolian with whom foreigners have recently had contact has been a Mongolian in transition from the nomadic to a more settled and routinized life of communism. The Mongolian's dislike of work-discipline and especially set hours, characteristics of work in the modern environment, has only too frequently been interpreted as a dislike of work per se. What the emergent modern Mongolian has disliked is not work as such but rather work in a factory where he must do a specified task for a pre-determined period of time, literally day after day. This is not natural for him; that is, it is not consistent with his upbringing and the life for which he was conditioned for generations. Today's Mongolian, however, is undergoing change in this respect, among others. Today's children, much more than their parents, are likely to have spent long hours in school, doing things specified by others more or less on schedule (as factory, office, and other workers do). And the evidence suggests that these younger Mongolians are differing increasingly from their elders in terms of their reaction to the routinized labor characteristics of the kind of modern country the Party is trying to create. At least two attitudes towards work, however, characterize the Mongolian today. The worker on a state farm is seemingly motivated mainly by the incentive of income. He works because he must have money to support himself and his family. And, if he works unusually hard and well, he may be given a better job at a higher rate of pay. Given comparable tools and a seemingly sufficient education, it still takes three to four times as many Mongolian workers to do what a single Western-trained worker can accomplish. Moreover, there is evidence to suggest that the Mongolian worker may often do his job wholly out of fear of reprisal for failing to do it. The incentive to work is thus often more negative or punitive than positive or rewarding. An explanation of such attitudes and behavior is to be found in the culture of a country still very much in transition from a nomadic life to the very different kind of existence represented by the more confining and disciplined demands of a modernizing society. The country is still far from modernized, and it should come as no surprise that the individual men and women who make up the society also still have a long way to go along the complex road to modernization. Holidays Mongolia's holidays, like its life-ways, have undergone great change since the Communist revolution. Before the revolution, most of Mongolia's holidays were religious ones, and all had religious aspects. The frequently bloody effort to uproot the traditional faith of the land (especially in the 1930s) could not help but take its toll among the religiously inspired feast-days of the country. At the same time, however, the activities which today occupy the Mongolian on his holidays are surprisingly similar to some of the ways in which he passed his religious festivals in pre-Communist times. Archery, wrestling, and horse-racing contests are particular cases in point. There is both old and new in the ways Mongolians celebrate their holidays today. The official holidays of the MPR include V.I. Lenin Day (January 22), International Solidarity of Workers Day(s) (May 1-2), Constitution Day (June 30), Independence or Revolution Day (July 11), and Great October Socialist (or Bolshevik) Revolution Day(s) (November 7-8). Mongolian New Year's Day, known as "Tsagan Sar" (or "White Moon"), varies in its precise date from year to year; it is the same as the "lunar new year" observed by many other Asian peoples. August 29, the anniversary of the victory of the Mongolian and Red Armies over the Japanese on the Manchurian border in 1939 is observed as a military holiday, although it is not clear whether it is a national one. The most widely celebrated holiday of the year is the National Nadam-which has been designated a "national and state holiday" and is observed in Ulan Bator during the 4-day period June 12-15 both by the country's most important sports activities (a holdover from ancient times) and by military parades, drills and maneuvers, as well as track and field sports (innovations of the Communist period). The old is thus retained by the "new order" and used by it for political and other purposes. Besides the National Nadam, there are also preliminary nadams for the various aimak centers (of 3 days), and the somon centers (of 2 days). The dates for these local nadams are set annually by the Council of Ministers. Only the Mongolian New Year's Day and the National Nadam were nationally observed holidays before the Communist revolution, though there were many religious festivals now suppressed. These traditional holidays, however, like the newer ones, are used by the government to encourage support for various objectives of the regime. Leisure Activities The most traditional and still the most popular recreational activities of the Mongolian people as a whole are the great sporting events associated with both their former and present holidays: Archery, wrestling, and horse-racing. Motion pictures, among other activities, are increasingly popular among young people, and the radio occupies countless hours during the long winter nights, but the crowds and their excitement (at Nadam as well as on other occasions) testify to the continuing attraction of the historic athletic competitions. Rules in the various Nadam competitions were laid down hundreds of years ago-and outstanding performances of 20, 30, and even 50 years ago are fondly recalled by oldtimers. The archery competition goes back more than 1,000 years, and skillful indeed are Mongolians at archery. The bow is made of wood laminated with horn with a double curve, and is strong enough to shoot an arrow as great a distance as can be done with the English long-bow. The arrow is a meter in length, and feathered to rotate in flight. The archer shoots, in one of the competitions, at a sandbag tossed on the ground 100 meters away; in another, he aims at a low line of colored blocks. His arrow first rises and then descends toward its target - with the crowd on its feet and excitedly predicting the outcome of the shot. Horse-racing also differs from its counterpart in the West. The distance travelled is usually either 19 miles (25 kilometers) or 37 miles (50 kilometers) and the horse is tested more for his stamina than his sprinting ability. The role of the jockey is limited, and it is rare when a boy (or girl) older than 10 rides a horse in competition. The rider's function is to guide the horse, more than to force him. Spurs are not used, but a short whip is carried. Horses, moreover, are not retired at an early age in Mongolia. Some have been known to compete in Nadam and other competitions up to 20 years of age. Wrestling is the third great Mongolian sport, and there is practically no male in the MPR who has not wrestled in one competition or another sometime in his boyhood or early manhood. Mongolian wrestling is more like traditional English wrestling than any other variation of the sport outside the country. A match is won when any part of the body-other than the bottom of the contestant's feet-touches the ground. Mongolian wrestling, however, is also a pageant as well as a sport. When the wrestlers enter the ring, they engage in an eagle-like dance, waving their arms furiously and seemingly flying around the arena. They are also each accompanied by a kind of herald, who may recite a poem proclaiming his patron's physical prowess before the match and who is constantly cheering the accomplishments of his man and bemoaning the advantages of the opponent, all in verse. In a not dissimilar fashion, the four leading horses in a race will be brought before the judges and spectators some hours after the completion of their competition, led by silk-clad heralds, who recite poems of their own composition celebrating their animals. Sometimes such poems move the audience to loud appreciative applause. Suffice to say that there is probably as much poetry in the sports of Mongolia as any country in the world. The physical and the lyrical went hand in hand in the religious-sports competitions of yesterday, and their union persists even in present Communist times. Skiing is another traditional sport that is popular in the MPR but less so than might be expected. Volleyball is widely played by the young-and requires a minimum of equipment and cost. And soccer and basketball, both imports, are rapidly increasing in popularity. Ulan Bator, the capital, boasts a 15,000-spectator soccer stadium and a 2,500-seat indoor coliseum. Non-athletic pastimes have also grown in popularity in the 40-plus years since the MPR came into being. There was a pantomime-type drama in old Mongolia, in which both monks and laymen participated (wearing masks) and which was devoted to religious themes. Such drama has long ago died. But theater, of an increasingly cosmopolitan and universal character, is on the increase. "King Lear" was among the presentations staged in Ulan Bator in 1964 in commemoration of the international Shakespearean year. Ulan Bator, however, has only one real theater for live presentations, and the physical arrangements are less adequate the more remote the city or town is from the capital. Among young people in particular, motion pictures have a great drawing power. Ulan Bator has six cinema theaters-and all of the provincial centers have at least one building specifically constructed to show films, as do many of the lesser towns. "My children want to go to the movies every week," one mother told a visiting scholar. The films are mostly of Communist origin-coming principally these days from the Soviet Union and the Eastern European countries. Their impact is probably much more than just recreational. Some, however, have almost impossible titles, like "Love at the Apartment Construction Site," a locally made offering. There is also a discernible trend among the young towards Western popular music, including jazz and rock, in preference to the more traditional melodies of the country, and recent compositions created in their image as well as Western classical music heard frequently on the radio. Two American-style juke-boxes were imported (from East Germany) for a recent national Nadam, and the music was hardly that of ancient Mongolia or even the Communist world: Petula Clark, Glenn Miller, the Beatles, Dean Martin, Frank Sinatra, Elvis Presley, the Animals, the Yardbirds, and the Rolling Stones being featured, among others. During the long and cold nights of the Mongolian winter both chess and checkers are popular among young and old. Gambling, however, is not widespread in the country. The Mongolians drink intoxicating beverages (vodka increasingly as well as their traditional airag) and drunkenness is common enough to be the theme of a voluminous propaganda. For those in the cities (particularly Ulan Bator), window-shopping seems to be a frequently pursued social activity. Of night-life as it is known in the West, there is very little (see ch. 21, Public Order and Safety). Health The people of the MPR are as healthy-looking as those of any other Asian country. Their good white teeth immediately attract attention. One recent visitor, however, listened to a father's complaint that the increasing consumption of ice cream and sweets unknown in his day was causing cavities in his children's teeth. There is none of the trachoma that, unfortunately, mars the appearance of many Asians, and is also suggestive of their living conditions. Historically, the Mongolian people have experienced a high infant mortality rate. A 1914 Russian study, for example, revealed that almost half of all Mongolian babies died before they were 3 years old. Public health activity, however-especially in the last generation-has increased life expectancy considerably and sharply reduced infant mortality. The claim is made that infant mortality had been reduced to 5 percent-and, while this is probably an exaggeration, it is true that urbanization, hospital construction, medical training, and greater emphasis upon public health than upon any other social welfare activity has resulted in outstanding progress in keeping babies alive beyond their first years. Eight out of ten babies are today born in hospitals or maternity homes-neither of which were even existent at the time of the 1914 Russian study. Life expectancy was low in pre-modern Mongolia, although reliable statistics are not available. There was even some fear that Mongols as a people might die off-partly in response to the frequent famines brought about by weather-caused destruction to their herds, and party because of their small families. The average Mongolian family on the eve of the revolution had only 1.8 children, which is low for a pre-modern people who also practiced no type of birth control. This was partly the result of the high rate of infant mortality and partly because of the large number of unsuccessful pregnancies, both at least partially due to the prevalence of venereal disease. Since the Communist takeover, and especially after World War II there has been a noticeable increase in population growth-largely the consequence of public health measures. The birth rate in 1960 was 43.2 per 1,000, and the death rate 10.5, both low. Between 1955 and 1958 there was actually an absolute decline in deaths (from 11,800 to 9,900) in spite of the fact of the country's growing population. Prevalence of Diseases Today's Mongolian is much healthier than his ancestor of half-a-century ago. Epidemic diseases, syphilis, rheumatism, and trachoma were quite prevalent 50 years ago-the latter two maladies mainly the result of the inadequate ventilation, heat, and lighting of their housing facilities. In the more remote parts of the country, some of these facilities are little changed even today, and for this reason mainly, these illnesses are more likely to be found in such areas. The relatively modern wood and coal stoves to be found in today's gers, not to mention the increasingly more numerous steam-heated apartments, are a major improvement over yesterday's dung-burning fire pits. Some gers today boast electricity, and, where non-electric lamps are still used (which is probably for about half the population), these are of the non-smoking variety. Diseases due to vitamin deficiency were not particularly prevalent in the pre-modern period. The current Mongolian diet is probably deficient in vitamins by American standards. Malnutrition, however, was not formerly, and is not today, widespread. The only exception to this generalization were those periods in the past when weather disaster killed off great herds of cattle and other livestock. As might be expected, winter respiratory diseases are prevalent-as they have apparently always been. In the recent past, pulmonary and bronchial infections, and undulant fever were very widespread, and there was in fact a generally high incidence of sickness. Most of these diseases have been brought under control in recent years, however-sometimes through the employment of indigenous methods (particularly the use of airag, which has demonstrated therapeutic qualities). Smallpox, once fairly widespread, is said to have been eliminated altogether. Cholera, typhus, and other epidemic diseases have also reportedly been all but wiped out, and tuberculosis is in the process of being overcome. Indicative of the response of public health authorities was the effective national vaccination campaign that followed a 1963 polio outbreak. Problems of Sanitation Some of the health problems that afflicted Mongolians in former days, and even in present times, have their roots in indifferent sanitation habits. Historically, the Mongolians showed little concern for questions of sanitation, and there may be in the more remote portions of the country people who have never in their lives taken a bath. Moreover, those who did bathe often have used contaminated water. In the past, and again today, such bathing took place in a river or stream in the warmer summer months. The same river or stream, polluted by both men and animals, was also used as a source of drinking water. Drinking water was not boiled or otherwise purified. Tap water today is fairly safe where it is to be found, but, where it is not found, water is probably not boiled before drinking, even at the present time. Wells were often fairly shallow and, more often than not, exposed. Dysentery was widespread where there was any concentration of people, and is still a problem, though of diminished proportions, in the cities. There were other sanitary problems that posed major health menaces in the past. Persons stricken with contagious diseases were not quarantined and men and women alike were prone to perform their excretory functions almost anywhere. There has been great improvement in all of these conditions in the last generation. All of the government-built apartment houses have modern bathrooms, though these must be shared by several families. School children are regularly examined to prevent the development of epidemics, and quarantine regulations are apparently well enforced. The sewage systems of Ulan Bator and Sukhe Bator are comparatively new and function satisfactorily. In other areas, however, there are sewage problems. The ger does not ordinarily contain a bath tub. The emphasis on preventive medicine in the MPR's public health agencies, however, suggests the likelihood of continued progress in the sanitation field. Medicine and Medical Institutions Monks were the closest things to doctors in historic Mongolia, and their practices combined Tibetan folk-medicine and shamanistic superstitions. The practices of the monks were virtual sorcery in many respects, and sometimes they were outright harmful, as in the case of a kind of primitive vaccination which attached smallpox scabs to the nasal membranes of small children. The masses had faith in these emchi, as they were called, however, and resisted the introduction of new medical techniques no less than the monks themselves. Primarily as an accommodation to a part of the old order as they prepared an assault on the society as a whole, Mongolia's new Communist rulers actually subsidized the emchi out of the government budget until 1930. There was not a single trained medical doctor in the country at the time of the revolution. The first Soviet doctor did not come to the country until 1923. There had earlier been "medical assistants" attached to the Soviet military forces, but these were at the technical level of first-aid men. If Mongolia was to improve the health of its people, it was obvious that local personnel would have to be trained, by experts and knowledge imported from abroad. The strategy was the development of a core of medical "cadres" who would serve as the means of transmission of improved medical and sanitation habits to the population as a whole. A 2-year medical-technical school was opened in 1929-but its first class was not enrolled until 1931. Considering the fact that Mongolia had no doctors a decade earlier (and ignoring for the moment the matter of quality), there were in the country by 1930, 25 hospitals with 350 beds, 16 doctors (all foreign), 21 assistants, and 23 nurses. There was also established in the same year the country's first pharmaceutical institution. In 1931 the first tuberculosis clinic was opened as well as the first venereal disease dispensary. The process of supplanting traditional Tibetan folk-medicine practices with modern European methods was well underway. Between 1932 and 1940, 20 new hospitals reportedly were opened, and the overall number of beds increased to 1,411. According to a different Soviet source, however, there were fewer hospitals (only 17 in all) but more hospital beds (1,733) by 1940. In either case, the accomplishment was no modest one-given the MPR's backward state at the time of its inception, the absence altogether of a scientific or medical tradition, and the preoccupation of the Soviets with their own nation-building and other problems. It was in 1938 that the first four Mongolian nationals, educated in the USSR, began medical practice in the MPR. Two years later, the Mongolian State University was chartered with three colleges: medicine, veterinary medicine and pedagogy. By 1951, this institution had graduated 400 students (although the proportions of medical to other personnel are not known). The first medical graduates of the university did not go out to practice until 1947, however, suggestive of a lengthy and responsible period of training-by which time, according to a Soviet source, there were 582 physicians and medical assistants in the MPR. Besides the hospitals that existed in 1940, there were also 150 to 350 first aid stations in the aimaks and communes up and down the country (the number again differing with the source). The 1940s saw another increase in the number of facilities-the precise count differing once more with the source. The number of hospitals increased either from 17 to 37 (or up to 50 or 52); one source indicated an increase to 2,091 in medical stations, another to only 422. An explanation for these differences may be found in part in the definition of properly constituted hospitals or medical stations. The increase in hospital beds brought the total to figures variously reported as 3,200-plus to 3,800. In any event, there was growth. Ulan Bator itself had three full-fledged hospitals. Other growth there also was. Reportedly, there were 63 pharmacies in the country by 1949, 116 "maternity hospitals," and approximately 100 obstetrical stations. (It is not known whether the distinction is really a difference.) A Soviet publication, issued in 1961, claimed a three-fold increase in the number of hospitals in the two-decade period 1940-1960 (which seems quite large). Every aimak reportedly had a well-equipped hospital by 1967, with bigger, more specialized "inter-aimak" hospitals at Choibalsan, Tsetserleg, and Jirgalanta. All major industrial facilities, railway-worker settlements, state farms, and agricultural communities were also supposed to have "polyclinics" or "medical stations." By 1961, there reportedly were 870 doctors in the MPR-500 of them allegedly having received their degrees since 1956. The target of Mongolian planners, however, was to graduate 100 doctors a year, beginning in 1955-and this figure, if true, would indicate success. This would amount to one doctor for each 903 Mongolians, a major achievement for a country which had no doctors at all of its own nationality only a quarter century earlier. Further, by 1965, a ratio of one doctor per 770 persons, and the availability of 10,000 hospital beds were officially claimed. These figures, if accurate, would place the MPR second in all Asia (behind Japan) in the number per capita of available physicians and hospital beds. Ten percent of the total government budget is being spent on health and health-related services, but even government sources have described them as poor. They cannot, however, even be compared with conditions 50 years ago. Government Provisions for Welfare A department of public health was created by the government as early as 1925, 13 years before there was a Mongolian-national doctor in the land. Although it had little concrete to offer, it was the first institution in the country's history to offer free medical assistance to anyone, with or without funds. A special Ministry of Health was created 5 years later to administer such regulations and benefits as existed in this field. There appears to be no central agency for the administration of welfare benefits not associated with health. Medical assistance, including hospitalization and the practitioner's services, were then, however, and still are totally free, though obviously the citizen pays indirectly through taxes. The MPR, indeed, boasts a very broad general program of social insurance for its citizens. These services include, besides free medical attention, temporary disability payments as well as permanent disability pensions and old age assistance, unemployment payments, aid to expectant mothers, burial costs, free or low cost access to government-operated health resorts, and relief payments for persons prevented from working because of illness or injury suffered by other members of the family. Members of trade unions receive much larger benefits than non-members for disability relief, it should be noted, and certain more risky jobs, such as mining, pay bigger benefits. Medical examinations are both strict and fairly frequent to cut down on false claims and unjustified reluctance to return to work. The pension law, promulgated in 1957, provides old-age pensions for men at the age of 60-if they have worked for 25 years-and for women at 55, if they have worked for 20 years. The size of the benefits is based on the wages earned by the worker as well as on the number of years he has worked. Expectant mothers are given maternity leave, and, to bolster what is a comparatively modest population for such a sprawling country, state aid, as well as titles of honor and medals are given mothers of large families. Expectant females are given 45 days leave both before and after delivery of their babies. The payments to mothers are not especially large for small families but mount quickly for bigger ones. Thirty-five tugriks are given each mother-plus an additional 18 tugriks a month for 9 months after birth (in addition to completely free medical and hospital services). Payments of more than 440 tugriks a year for five years are paid in the case of fifth, sixth, and seventh children. For eight or more children, a mother receives 2,000 tugriks in a single lump-sum payment-plus about 1,000 tugriks a year for 4 years. The various welfare benefits proclaimed by the MPR are rooted in the country's constitution-which provides that all citizens "have the right to material assistance in old age as well as in the event of illness and loss of the capacity to work." What is only imperfectly known is how these benefits are applied in practice. There are increasing numbers of hospitals that have patients who do not pay for the services they receive. In the 1930s, budgetary appropriations for medical aid increased five times, a measure of the growing benefits actually provided by the state. Less is known about the functioning of other aspects of this system of welfare benefits.