Security Pie

Once in a while, you get to a place that changes your outlook on life and everything that you hold to be a “basic truth”. Mongolia is one such place. Everything from literacy of nomads (98% !!!!) to happiness to the importance of time (Mongolians – outside of the capital UlaanBaatar - measured time in what seems to be seasons, not hours or even days).

One of the challenging ones for us, a group of mountain bikers which consisted of 3 1/2 engineers and 3 1/2 doctors, was the consumption of red meat and cheese in Mongolia. That surely, cannot be healthy: can it?

When I mean red meat and cheese, I mean ONLY red meat and cheese, and perhaps some flour to make Tsuivan, some sort of a chewy noodles and boiled mutton, which, when properly seasoned, is not bad.

Tsuivan is homemade sticky noodles with boiled mutton and little spices

The red meat and cheese are sourced from the family’s herd (read: equity), and the flour is purchased. In fact, a bag of flour or rice makes a great gift for a ger family you decide to squat upon (they are the friendliest of people, which makes the fact that they speak no English very disappointing).

Now here’s the clincher: They eat very little, if at all, vegetables. And I mean very little. The markets in the aimag centers (regional capitals) may have 2-3 vegetable stands, and that is it.

No oranges, no celery, no Belgian endive (faint), no lemongrass or galangal, no apples, no…

So a bag of flour per family (pyramid base somewhat covered), NO Fruit or vegetable group whatsoever, milk and cheese in the summer (and butter and aruul in the winter – aruul is a rock like dried milk curd).

 

Milk curd (aruul) drying for the winterand lots and lots of red meat (breakfast, lunch and dinner). And salty tea. Meat for breakfast, meat for lunch and meat for dinner

So where do the Vitamins come from? How do they keep healthy? Surely they must die young?

Well, not as you’d expect. On average, Mongolians live 65.5 years, according to figures released by the World Health Organization. 

This places Mongolia with countries such as the Philippines, with 67.5 years, and slightly ahead of India where the average lifespan is 63 years. Other Asian countries included South Korea at 78.5 years and North Korea showing an average life span of 66.5 years. 

The report noted Singapore had an average lifespan of 80 years while China is 72.5 years.  

The shortest lifespan recorded is in Swaziland, where average life expectancy is 37.5 years. Sierra Leone followed at 38.5 years and Angola and Zambia both had average life expectancies of 40 years.

Mortality is really affected by the remoteness of the living conditions. In the winter, if you get a cold, it is unlikely you’ll make the trip to the aimag center alive (at -30 degrees Celsius).

What does this mean? To me it is a sure sign that you must always question even the most basic assumptions. The assumption that they food pyramid is correct might be applicable to the US, but is far from correct for Mongolians. Why this is so is not clear to me or to my fellow bikers. Our guide had a theory that Mongolian’s developed a capacity for eating meat, which we summarily dismissed. But we did not come up with a better idea.

How can we be in the 21st century with so little understanding of how food, the most basic requirement for life, works?

Comments welcome. 

Some more data from the BMJ:

Mongolia: a health system in transition. 

Manaseki S.

Arrowe Park Hospital, Upton, Wirral, Merseyside.

PIP: 70% of the 2.2 million population of Mongolia are younger than 35 years old. More than 75% of the population live in urban areas, but many adopt the traditional nomadic lifestyle for at least a few weeks each year. 95% of the population is literate. Winters produce extremely cold temperatures and shortages. Mongolia has a well structured and staffed health care system. 3.9 physicians serve 1000 people. Women comprise more than 80% of physicians. Leading causes of mortality and morbidity are acute respiratory infections (ARIs) in the winter and diarrhea in the summer, particularly among children. Hypertension and ischemic heart disease are common. Mongolians are the greatest consumers of red meat in Asia and perhaps the world. The health system is in the process of switching from a centralized system of specialist clinics to a family doctor system. Family doctors usually are general physicians, pediatricians, and gynecologists who have undergone family doctor training. They have not received adequate training in treating ARIs, however. Family doctor clinics have 3-6 physicians, each physician with his/her own nurse. Each physician cares for 200-350 families (350-600 children younger than 16). Family doctors must visit each newborn every 2 weeks for the first 3 months and then once a month until age 1. They must also visit each elderly and homebound chronically ill patient at least once a month. Their nurses either come with them or visit patients alone to administer injections, change dressings, take infants’ measurements, and encourage persons to come for vaccinations. The small district and county hospitals face shortages of drugs, raw materials, and functional equipment. The few national hospitals provide tertiary care. Treatment without medicine and traditional treatments of herbal remedies and Buddhist rituals and prayers are resurging in popularity. Harmful practices include swaddling babies, which contributes to rickets and pneumonia, and giving ill children their mother’s early morning urine. Immunization coverage is high. Supplementary ration cards provide milk, flour, meat, rice, and sugar to pregnant women and mothers of children under 1 year old. Milk centers in major towns provide milk to children with a doctor’s prescription. Even though malnutrition is rare, vitamin deficiencies are common.

PMID: 8292957 [PubMed - indexed for MEDLINE]