A team from Physical Medicine and Rehabilitation in Rochester traveled to Mongolia to share their knowledge about treating people with spinal cord injuries. They recount their experiences and what they learned.

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Lisa Beck knows a thing or two about spinal cord injury care. It has been the focus of her entire nursing career, and she has been involved in creating patient education materials on the topic at Mayo Clinic.

Beck, an advanced practice nurse, and others from Physical Medicine and Rehabilitation recently had the chance to travel to Mongolia and share their knowledge about caring for people with spinal cord injuries.

Beck first traveled to Mongolia in 2019 as an instructor in a spinal cord injury training program in partnership with the Mongolian Ministries of Health and Social Welfare. The program was created to help train staff at the National Traumatic and Orthopedic Hospital in Mongolia on care for people with spinal cord injuries and reduce the length of hospital stay, which then was 10 to 14 days, regardless of the severity of the injury or medical complexity.

Since that time, there has been an increased interest in establishing a spinal cord injury rehabilitation center — the first of its kind in Mongolia — within the Mongolian National University of Health Sciences. The university trains many of the healthcare professionals who provide care in the country.

During their 2023 trip, the team from Mayo built on previous training programs to strengthen the knowledge and confidence of the multidisciplinary team at the National Traumatic and Orthopedic Hospital in caring for people with spinal cord injuries.

Darcy Erickson, an occupational therapist, assistive technology professional and wheelchair specialist at Mayo Clinic, says she was inspired to join Beck and others on the trip since Mongolia does not have access to wheeled mobility through its healthcare system or even in its own country. That means people have to purchase wheelchairs privately from other countries and wait months to receive them. 

"Persons with spinal cord injuries often rely on wheeled mobility for every aspect of their life — to care for themselves and their families, work and engage in community responsibilities," Erickson says. "A wheeled mobility device is not just a way to get around, but a way to engage in life."

If the device does not fit a person properly or is inaccessible in their home, workplace or community, the person can have significant health challenges, she says.

"Providing opportunities to educate and train other occupational and physical therapists on spinal cord injury rehabilitation, wheeled mobility skills, selection, seated positioning will help current and future patients be more informed and help improve health outcomes," Erickson says. "Meeting people living with a spinal cord injury in Mongolia and helping them learn more about their care options and equipment was especially rewarding."

Others on the trip were Jeffrey Brault, D.O., Benjamin Holmes, Ph.D., and Ronald Reeves, M.D.

The trip was funded through scholarships from the Mayo Global Health Program.

Mayo's News team caught up with Beck to learn more about the purpose and inspiration for the trip.

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Why Mongolia, and why now?

Mongolia is a multiparty democracy that adopted a new constitution in 1992. Since then, it has fostered a growing economy. Mongolia's economy — driven by mining — is expected to grow by 5.6% in 2023. There is a hub and spoke system of care, facilitating referrals from the rural portions of the country into specialty centers in its capital, Ulaanbaatar. The Mongolian National University of Health Sciences, one of the lead organizations in this effort, is the primary university in the country responsible for the medical training of physicians and allied health staff.

Given these factors, a healthy economy, a growing healthcare system, and a respected university, the likelihood of success in developing, opening and sustaining a rehabilitation hospital in Ulaanbaatar is high. Therefore, a sustained, long-term relationship between Mayo Clinic staff and rehabilitation professionals in the Mongolian National University of Health Sciences will provide the opportunity for patient referrals to Mayo Clinic for subspecialized services not available in Mongolia.

Additionally, the ongoing relationship will continue to provide opportunities for educational collaboration and may foster research collaboration as well.

What kind of difference were you able to make in Mongolia through this work?

This education project provided didactic and hands-on training to interdisciplinary team members, training the trainers regarding the rehabilitation care and education of people with spinal cord injuries. We were able to train and educate approximately 80 providers — mostly physicians and physical therapists, with smaller numbers of occupational therapists and nurses — on the unique needs of people with spinal cord injuries. While a formal rehabilitation unit has not yet been built within the Mongolian National University of Health Sciences, it is planned in the schematic design housed in the lobby of the facility.

What were some of your most memorable moments there?

I was invited to speak with the nursing staff at the university hospital with really no guidance on the topic. In my research, I learned that a nursing career is not a highly valued job. It's described more so as following the orders of physicians. I wanted my talk to be inspirational, to make the nursing staff aware of all the opportunities within the role of nursing, as well as advancements such as certification and advanced practice.

The talk was scheduled the day before International Nurses Day. I could not have been more excited to give a talk during such a time frame. After the talk, three nurses from a different hospital asked if I had time to speak with their staff while in town. Unfortunately, we only had one more day and were unable to do so. Many of the nurses requested photos of themselves with me.  I was so honored and humbled to be there.

My second memorable moment was the last day with the people living with spinal cord injuries. I had spoken to a group four years ago, as well. This year, I decided to split the group and only take the women to discuss bowel, bladder and sexual function. The men met with Dr. Lee. I kept the discussion very informal to answer questions or concerns that they had. They enjoyed the small group and felt that they could chat freely. I also had one woman that I met four years ago return. She reminded me of a tip that I gave her in 2019 and that she continues to use in her daily life.

What did you bring back with you to Mayo Clinic?

I am reminded of how we can still provide excellent care to people with spinal cord injuries without expensive equipment or technology. We have patients who come to Mayo Clinic with limited resources or who are from remote areas that do not have spinal cord injury specialists within reach. This experience continues to drive me to help provide resources for the clinician who isn't trained in spinal cord injuries, as I have been doing via the American Spinal Injury Association. 

I have shared resources developed with our own primary care providers here at Mayo Clinic and have spoken at morning rounds regarding the unique needs of people with spinal cord injuries.

How is the team's time in Mongolia influencing your work at Mayo Clinic?

People with spinal cord injuries in Mongolia receive limited patient education materials. Much of how they learn about the changes secondary to spinal cord injuries is via social media. I see the importance of sharing our well-developed patient educational materials outside Mayo Clinic through our website. I hope to enhance the information we provide externally regarding spinal cord injuries that can be translated into other languages, as well.

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