medical

April 1, 2014

Knock on wood; I’ve been a healthy person. It’s not something I’ve taken for granted; many a Thanksgiving my health has topped the list of things for which I am thankful. But, living in a developing country presents new challenges and managing even a run-of-the-mill cold may require more effort here than at home.

The two Peace Corps Medical Officers (PCMOs) in UB are responsible for our well-being. During PST, they give numerous trainings covering general health concerns and those specific to Mongolia. Topics covered include: alcohol (including the alcohol content of different drinks, alcoholism, alcohol as a means of escaping or coping), mental health (including the warning signs of depression and the methods of coping), dog bites, healthy eating (to the extent possible in soums with few vegetables), medications (which to use for which symptoms, what’s available in our individual med kits, what’s available by request from the PCMO), and sexual health issues (including sexual assault, alcohol and sex, Sexually Transmissible Infections and how to prevent them, and exploring the reasons people engage in sexual activity). That’s not an exhaustive list. Outside of trainings, our PCMOs also take care of in-country vaccinations, flu shots and annual physicals. When something goes wrong while we are at site, they make the decision to get us to UB so they can examine us in person. And if something goes really wrong, they make the decision to send us to Thailand for treatment. They are available 24/7 via an emergency number; of course, we are advised to troubleshoot non-emergency issues on our own first.

The Health Manual answers basic questions of symptoms and preliminary treatment and allows us to triage the more serious issues to the PCMOs. My first experience with the Health Manual was shortly after my arrival at site. I had an earache which isn’t something that I’m prone to getting. The earache was mild and short-lived so I never bothered with contacting the PCMOs about it. But I learned from the Health Manual that “for some inexplicable reason, a few Volunteers will develop excessive earwax during their time in Mongolia.” And it was true! For a while I was thinking to myself, “where’s all this ear wax coming from?” But since it wasn’t cause for concern, it wasn’t worth mentioning. I imagine it has something to do with the different climate and altitude and it’s probably further proof that I’ve adapted since over the 22 months here (wow!), my earwax has returned to “normal” levels.

The med-kit contains a medley of over-the-counter meds, a pair of rubber gloves, water-purifying tablets, rehydrating salts, condoms, an ace bandage, gauze, generic band-aids, bug spray, sunscreen, well, here’s a picture.

med_kitIf we need a resupply of things, we can request via phone call or email and they’ll mail it to us at site. I’ve gotten PCMO packages in 2 days!

The PC/Mongolia Cook Book I’ve touched on briefly before. But let me highlight the best thing about it, and where it differs from other cook books I’ve owned. This cookbook has recipes which only use ingredients we can get here. Other recipe books wanted fancy ingredients that I didn’t know where to buy or would only use a portion of before the remainder would spoil. This cook book is divided into two sections, Hungry Hudoo (for the Volunteers living in the countryside with fewer options) and Posh Corps (for the Volunteers in UB and those of us who have more variety). What this means is that I can make any of the Hungry Hudoo recipes and many of the Posh Corps recipes (except for the fact that I don’t cook meat or have an oven). But, armed with this cook book, I’ve learned to make: vegetarian chili, ginger tofu, black bean burgers, lentil burgers, any bean falafel, risotto, curry carrot soup, tomato soup, corn chowder, sweet and sour beets, peanut sauce, hummus, tzatziki, tortillas, no-bake cookies, rice cooker cake, and best of all, rice cooker brownies!!!

My reason for writing on this topic is that over the last 2 weeks I’ve had some experience with the Mongolian hospital in town and realized that I never really posted about our medical care here. So, now that I’ve done that, I’ll recount my experience.

Around the beginning of March I had a cold, nothing serious. The symptoms were a shallow cough, which morphed into a sore throat, before settling into a runny nose accompanied by sneezing a week later. I’m well familiar with Upper Respiratory Infections and back home I’d suffered through far worse symptoms before finally going to my Primary Care doc only to find I’d had walking pneumonia or bronchitis. I wouldn’t say I have a high tolerance for pain or am averse to medical treatment, but just that I procrastinated until I couldn’t any more.

But, with this particular cold, on a Tuesday night after English club, I felt a double earache coming on, the right side worse than the left. And, since I’m less familiar with these than the URIs, I consulted the Health Manual. I learned that earaches after colds could be a middle-ear infection, and that complication included a ruptured eardrum with the possibility of temporary hearing loss. As the pain was getting worse, I started freaking out a little (as much as I can freak out, which, to look at me, maybe you wouldn’t have known). I didn’t call the PCMO emergency number because, I reasoned, there was nothing they could do, or advise me to do, that would help immediately. I decided to call first thing in the morning.

It was a difficult night trying to sleep. The pain was worse when lying down. Sitting up didn’t help much, but it was an improvement. I’d taken Tylenol, which didn’t seem to make a difference, and I was worried about taking too many so I didn’t take any more. It was nearly 3am that I couldn’t stay awake anymore and tried to sleep.

When I awoke, the first thing I noticed was that there was no pain. Well, that wasn’t entirely true, but it was a 1 or 2 vs. a 5 or 6 (on that 1-10 pain scale) so I was relieved. I could tell there was moisture in my ear, and sure enough, a cotton swab (and my pillow) showed a slightly bloody fluid. I assumed a ruptured eardrum, but my hearing, though muffled, was still there. Big sigh of relief!

Long story short, after gathering the information, the PCMO (who, just a few weeks prior, had visited our very hospital) authorized me to visit the Ear, Nose and Throat doctor (which not all hospitals here have). Oyundar, the otolaryngologist, examined my ear, said, in English, “no puncture,” and reported back to an interpreter in UB who relayed the diagnosis to the PCMO. The PCMO then allowed me to be treated by the doc. That first day, when she inserted a 2-inch long strip of gauze, that had been dipped into a solution, into my ear, oh, joy! The remaining pressure I’d felt was relieved. And when I’d removed the strip of gauze 2 hours later, I could hear! It wasn’t permanent, meaning it blocked again when I blew my nose, but it was promising. I noticed that night, while lying in my bed in the absolute silence of night, that there was a bit of high-pitched ringing in my right ear.

Over the last 2 weeks, I have made 8 visits to the hospital. It’s pretty crowded in the lobby, where the registration window is, but I don’t have to register. Registered patients are given laminated, numbered tickets, just like you were at the deli. The ENT’s office is on the second floor, across from a pediatrician’s office, at the end of a corridor. One morning I counted 30 people waiting in the hallway. There are benches to accommodate 8-10 people. I wait alongside them, one day for nearly an hour, but once the doc knows I’ve arrived, she ushers me in and the visits are pretty routine. The door’s two glass panels are covered with opaque film, so waiting patients often poke their heads in to see what’s going on. During the third visit, the otolaryngologist charged me 10,500 tugs (about $6) to cover the total number of visits.

There hasn’t been any ear pain since that first night, and the ringing in the ear is gone (or, at least I can’t hear it anymore). She originally said 5 visits, so for the last 3 visits I’ve been asking, in Mongolian, “tomorrow, I don’t come, right?” But, she kept saying to come. Finally, today she wrote a prescription and we had to get the PCMO on the phone again, along with the translator. Turns out, she wants me to use steroid ear drops for the next three days. The PCMO approved this. She also wanted to give me an aloe injection. The PCMO rejected this. The doc and I were able to communicate using a sort of Mong-lish, and I understood that I am to take 2 drops every 8 hours, and return in 3 days. I took my script to the pharmacy and paid the 7,000 tugs (about $4) and remembered to ask for a receipt, my first time asking in Mongolian, so that Peace Corps can reimburse me.

I’ll be home in ~3 months and I look forward to hearing your voices in person!

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if you’d like to make a call

January 23, 2014

Cell phones in Mongolia are pay-as-you-go rather than by monthly plan. Peace Corps provided our mobile phones, but we are responsible for adding нэгж (negj or phone units). The expected cost is built in to our monthly stipend; I spend about 5,000 tugricks ($3) per month on negj, probably below average among PCVs. You can buy negj from almost any delguur (store). You can also get unlimited plans from the branch (e.g., Mobicom, G-Mobile) directly. Mostly, I think people go to the stores. Usually, the store has extra negj loaded onto their phone and they transfer to your phone and you get at least three text messages immediately confirming the amount. Another way you can get negj is by a little scratch ticket sold at the store. These come in denominations of 1,000 tugricks and 5,000 tugricks (maybe higher, I don’t know). You scratch off the code and type it into your phone and send. And, if you run out of negj at an inconvenient time, you can type in a code for an emergency 500 negj, and the next time you load up, they’ll deduct 550.

Nearly everyone texts, since it is cheaper than talking. Personally, I still really don’t like texting when it’s used for conversation. For a one-way message (“There’s cheese at the cheese store!” or “I’ll be a bit late to club.”), I don’t mind.

Curiously, many Mongolians have more than one phone. In my department, only the director has an office phone. All of the other education specialists use their cell phones, but I don’t think their different phones are specific to work or personal life. Also, it’s not uncommon for people to take calls in the middle of a meeting; or for teachers to answer a call in the middle of class.

Very young children in Mongolia have cell phones. I’m talking 6, 7, 8 years old is not unusual. Many high school students have smart phones and some will boldly listen to music or play games during class. And some will use their phone to access an English-Mongolian dictionary ap. In classes where there is a shortage of books, students will pass their phones around and photograph the page with the lesson, then use their phones to zoom in on the text. Talk about resourceful!

Mongolians have embraced all that modern technology to the point that flat screen televisions inside gers are almost expected. So, it was really surprising that one of the textbooks includes a lesson on electronic gadgets. That there was such a lesson wasn’t surprising, but that the lesson listed camcorder, electronic dictionary, PDA, GPS, and last but not least, pager, was quite amusing. Though I told the teacher these were outdated terms, replaced by today’s all-in-one gadgets, she was insistent on teaching the lesson as is. And, let me tell you, explaining to these kids in English how a pager worked would probably be the same as explaining it to American kids in Mongolian.

I leave you with this lovely image of a fellow PCV, Kevin, who confiscated 5 phones in one of his classes. Not sure I’d know how to use one of these.

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gifts

December 18, 2013

‘Tis the season for crowded shopping malls, wrapping paper, and stocking stuffers. Oh, who am I kidding? I’ve long since given up on the traditional presents, giving instead the gift of me. That is, time spent with me. Or, as I think of it, time spent with you. In a family where the next generation of kids wanted not for another toy, I saw it as a win-win solution to the obligation and stress of the holidays. And though my sister borderline shamed me as a “Grinch,” I held steadfast to my convictions: a movie, dinner, or play sprinkled throughout the year, or a big weekend in NYC, was more meaningful than a present under the tree. (BTW, there was no shaming when she was the one in Times Square!)

Right now, I’m missing that stuff. I miss planning the next adventure with the special someone. I miss creating those memories that will be relived and shared for years to come. Can you say the same about standing in lines; express shipping; paying that extra money for yet another toy to trip over or gadget that will be used twice a year? Man, this stuff gets me haughty!

So, what is gift-giving like over here in Mongolia? Well, it’s different for sure.

My first gift was to my host family. I’d picked up some See’s Candies lollipops from the San Francisco airport. My preliminary research (the facebook group for new Mongolia volunteers) suggested that candy was always a welcomed gift. I didn’t look further. Rule #1: your gift doesn’t have to cost a lot.

Immediately prior to accepting her box of lollipops, my mom rolled down her sleeves. This was mentioned in our cultural trainings. Rule #2: do not accept (or give) gifts with sleeves pushed up.

Then, mom took the gift and put it aside. This apparent indifference is typical Mongolian behavior. Rule #3: the recipient doesn’t react excessively to having received a gift (or maybe even react at all). You could also say that the opposite, squealing while gushing “thank you,” is very un-Mongolian behavior.

When mom did look at her gift, maybe 5 minutes later, she was curious and appreciative. Rule #4: always be appreciative.

The rest of these examples can be summed up as Rule #5: it is always okay to give a gift, and Rule #6: it really is the thought that counts.

In Govi-Altai I’ve had a few more encounters with gift giving. During my first month, I went to a wedding celebration for one of the school teachers. The mom invited the entire Education Department to her ger. The department presented a monetary gift (wrapped in a khadag), which I wasn’t asked to contribute to. Upon leaving the ger, each of us was given a travel mug and a crisp, new 500 tugrik note (about 30 cents).

Over the year, I’ve occasionally had teachers, students, and community members come to my home for help with English. Since that’s why I’m here, the prospect of a gift is literally the last thing on my mind; I’m just grateful to be utilized. But I’ve enjoyed packs of cookies, a jar of strawberries, a bottle of juice, and even a silk rose.

Tsagaan Sar, when you visit the homes of friends and family and eat (the same food) at each one, is the biggest holiday in Mongolia. (Last year I did it on a small scale, visiting only 6 homes.) It officially lasts a few days; unofficially, a few weeks. Each guest received an unwrapped gift which appeared to be kind of a random match. Among the items gifted were: a wallet, photo album, dress shirt (does it fit? who knows!), lamp, notebook, and Khan Bank calendar/pen set. The giving of the gift seemed to signal that it is time for you to leave. Brilliant!

To prove I’m no Scrooge, here’s some holiday cheer.


Soundtrack of a bus ride

December 9, 2013

I’d accepted that I wouldn’t go to UB until the COS conference in May. As it turned out, an opportunity to judge an English-speaking competition in UB came along and the coordinators offered to cover transportation and lodging for PCVs. Though my site is 1000km (600miles) from UB, making me a “fly-site” for Peace Corps, if I wanted to participate—and I did!—I’d have to take the bus. Nearly half the road is unpaved, so it takes at least 20 hours. Long-haul bus travel is something I was interested in doing at some point during my time here, since it is quintessentially Mongolian, but if I’d had the choice it would not have been on the cusp of winter.

10:00 is written on the ticket; I am on the bus at 11:00. The friend who helped to purchase my ticket hadn’t been satisfied with the seats available, so she comes on the bus and essentially evicts a girl from her seat—completely unnecessarily, I thought—so that I can have a “good chair.”  12:00 noon is the scheduled departure; we are finally on the road by 12:45. During this wait, several times I hear a classic Mongolian patriotic song as a ringtone.

12:45 As we drive out of Altai, the Mongolian band HURD is playing. You can also see the music videos on the large flat screen tv mounted above the driver. The band members wear all black, have the long hair of early Red Hot Chili Peppers, and they play ballads. I decide I like them.

15:00 “Hool idex uu?,” my neighbor asking me if I will eat when we stop. It seems early to me, but since I am not sure when the next stop will be, I ask “yamar hool?” (what kind of food). There are two options, tsuivan (a noodle dish) or soup. I opt for tsuivan.

15:30 The slurping of soup and tea. The tsuivan is exceptional.

16:00 More music videos. More HURD. Also, some Mongolian long song, which I find beautiful. English songs from a German band, Modern Talking, come on. I’ve never heard of them but their look is exactly that of the 80’s hair bands, yet their music video has 1998 on it so I’m totally confused. The sound of crunching peanuts.

21:30 Spinning wheels in the sand. We all (50-60 people) get off the bus.

22:00 Sounds of shoveling the sand from around the tires. “Neg, hoyeriig, guravaa…” the “one, two, three” before people try to push the bus, to no avail. Sounds of unloading the luggage from underneath the bus. Probably more shoveling sounds and more pushing sounds but by this point I’m stargazing on this moonless night with Florence and the Machine on my MP3 player, moderately concerned about the Return of the Frozen Toes that I am experiencing.

22:30 The sound of silence. We’re back on the bus; awaiting our fate.

01:30 A big truck engine. More shoveling.

02:30 The sound of the earth moving beneath our bus. Repacking the luggage. (Yes, in that order.)

03:00 The sound of people sleeping on a moving bus.

04:45 The beep of a text message received, likely sent 10 hours prior… I’d had no service all that time. Hey, my toes aren’t numb!

08:00 TV’s back on. The sounds of a Mongolian sketch comedy show. Very popular.  The sound of crunching snow underfoot while finding a spot to pee. I realize that men use the right side of the bus, and women use the left side, which means women must cross the road. But, I understand that it gives the women more privacy.

09:00 A crying toddler. The kid was here the whole time, and 20-hours in, I was ready to cry myself. I couldn’t blame her.

11:00 “Hool idex uu?”

12:00 Sounds of lunch.

Lunch spot. About 6 hours outside of UB.

Lunch spot. About 6 hours outside of UB.

16:00 People chatting. Ray LaMontagne in the headphones. Phone calls coming in and going out.

18:30 Sounds of UB.


boomtown

September 30, 2013

Since I can remember, my favorite time period in American history has always been the Industrial Revolution. Having always considered myself a “city girl,” I loved learning how the cities came to be. Even though I am from New England, I always found the Pilgrim-era to be dreadfully boring (colonies-shmolonies, yuck!).

I have a tendency to take things at face value so in my mind the Industrial Revolution existed as a neatly packaged inspirational anecdote summarizing the determination of the American will to grow. Of course, this was fanciful revisionist history and the more I learned (in Mr. Williams’ 10th grade IB World History class), I was able to remove the rose-colored glasses to see the hardships and poverty alongside the growth and prosperity.

Living in Mongolia, specifically, in Govi-Altai, I feel I am getting a sense of what it was like to live during a time of such growth. Just yesterday I heard that 24-hour electricity came as recently as 5 years ago to my aimag. The development here is fast and furious, in terms of construction, public works and infrastructure. There are the buildings, of course, too numerous to count. There have been improvements that make previous blog entries obsolete (manholes have been covered, streetlights are on). In a town with only two traffic lights, there were additions I didn’t know were feasible, including speed-bumps, lane dividers and signage. There is a public bus (for crying out loud!) that makes a two-mile loop, from the Education Department to the Hospital. And, it looks like my part of town is about to get a paved road and maybe even a sidewalk!

And, yet, as exciting as it all is, a part of me is mourning the loss of the blue sky that’s obscured with each new level.

Coming soon: Govi-Altai’s third 5-story building. I’m told these are apartments for sale, around 50 million tugs, or $30,000. That is considered pricey.

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This one has a garage underneath.

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A break from Soviet-era block-style housing, many of the newer projects have a corner chopped off. This is our new Performing Arts Center. This photo of one of our two intersections with traffic signals also shows a crew working on a streetlight and the swanky new signage (pedestrian crossing in the foreground, and the yellow square within a white square is a ‘through traffic’ symbol).

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Another building that went up in the past year (start to finish). I’m told the bright colors and patterns are also a response to the Soviet-era plain, drab, uninteresting block buildings.

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With a new bus, comes a new bus stop.

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This project began six or seven months ago.

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The “ruins” of Govi-Altai, juxtaposed with the contemporary, and indeed future, of building here.

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ECON 101, Mongolia edition

September 18, 2013

Effective September 1, 2013, Mongolia has a new minimum wage, 192,000T per month. The previous minimum was 140,400T, which meant that Peace Corps Volunteers were earning just over twice the minimum wage when I arrived last year.

Since we’re paid in togrogs, I know immediately whether I can afford something. There is an automatic conversion to a percent of my income that happens. I don’t have to convert the cost of things to dollars to know whether it is a good deal; I merely compare prices between delguurs, since most of what I buy is food. This means I don’t have to pay attention to exchange rates on a regular basis.

This summer, a German man was having trouble at an ATM in Govi-Altai. (He was riding his motorcycle from Germany to UB, another Other!)  He had planned to exchange a $100 bill, but it was Sunday and the banks were closed. (The fact that he had US dollars didn’t hit me until later; the international currency.) Since it was just a few weeks before leaving for my Russia trip, and I would need dollars to pay for my Russian Visa, I offered to take togrogs out of my account for him. (I had a brief moment of wondering whether the $100 bill I held in my hand was legitimate—I hadn’t seen American money in over a year!—but it was absurd to imagine that anyone would travel to Mongolia to launder counterfeit dollars.) I quoted him the last exchange rate I knew ($100 = 140,000T) and he agreed.

Turns out I got the better end of that deal, but not by too much. Now, take a look at this frightening graph showing the dollar to Mongolian togrog over the past year (from here).

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When I came to Mongolia last year, the exchange rate was about 1350T=$1. Now, it is 1700T=$1. Again, since I’m paid in tugs, I wasn’t aware of this. Of course, we were all aware of the notorious inflation in Mongolia. Initially, some of us thought that store proprietors were trying to take advantage of us foreigners by charging us higher prices than those posted, only to be told by locals that, no, the prices just keep going up. In fact, the economy had been expanding so rapidly that it was noteworthy when the inflation had slowed to below 10%. Still, with such high inflation, we can probably expect another adjustment to our living allowance, so, thanks, my fellow Americans.

Here is but a glimpse of the rising prices:
Shower was 1200T, briefly 1500T, now 2000T.
one egg was 350T, now 500T.
liter of milk was 1500T, now 2000T.
peanut butter was 5500T, now 9000T.
chocolate bar was 1400T, now 1500T.
3D movie in UB was 6000T, now 7000T.
large bottle of water was 600T, now 1000T.

Another interesting money tidbit is that the minimum ATM withdrawal is 1000T (which is now about 50 cents); you can get a decent ice cream cone for that price. Can you imagine taking so little from the ATM?!! Also, I used the ATM for many months before reading a message on the screen that there is a per transaction fee of 100T. So, for those who do take the minimum amount, the fee is 10%, which I know is only pennies, but still, 10%!!!! Since reading this message, I now take 100,000T at a time (unless I am lazy and press the 80,000T button, which is the highest pre-set amount).

One of my students showed me this: Sad Chinggis.

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Happy Chinggis.

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I know I’ve done this with George Washington. I love that there are such simple universal amusements.


shower-house

June 19, 2013

There was a shower-house in my training site last summer but, as far as I know, my host family never used it, so I never used it. I learned to bathe in my tumpun and my host-mom or host-sister would help me wash my hair by pouring the warm water over my head while I lathered and rinsed. The bathing and the hair-washing didn’t necessarily coincide. I would bathe every 7-10 days (using baby-wipes in the interim); I’d wash my hair every 5-7 days. Much like clothes washing in the tumpun, tumpun bathing was complicated by the need to carry the one bucket of water to my bedroom, combine in my tumpun with water from the kettle, bathe and then pour from the wide tumpun into the dirty-water bucket—hopefully, executing neither step with excessive spillage—finally, emptying the dirty water into the special pit outside.

With this as my frame of reference, the indoor plumbing at my permanent site made tumpun bathing so much easier, that I didn’t immediately seek out the Altai shower-houses. At site, I could fill (fill=2-3 inches) my tumpun right from the sink and, after washing, pour it right into the toilet. Even better was when the heat came on and my running water wasn’t ice-cold; then, I didn’t need to use the kettle at all. I’d gotten into a routine of upper-body bathing (right from the sink!), lower-body bathing, and hair-washing two days a week. The baby-wipes remain a living-in-Mongolia, must-have item.

I think at this point I should mention that when I lived in the States, my habit was to shower every other day. I’d adopted this schedule when growing up in California, because of “the drought,” and even though I’m sure I was in the minority to skip a day, it stuck with me and I saw no reason to change when I left. Like many routines, it wasn’t a hard-and-fast rule and if I needed/wanted a shower off-schedule, I’d take one. No judgment! 😉

After the new year, I asked my site-mate to show me the shower house. I think it was because the weather was so cold that I wanted that all-over warmth. That first shower in Altai, on January 10th, was gloriously warm. And, I remember thinking, “it’s so pleasurable to wash my hair without bending over.”

There are several shower-houses in Altai, but I’ve only experienced the one. The cost is 1300 togrogs (just under a dollar) for 30 minutes. There are two attendants: one collects the money (from the usage fee and the sale of toiletries) and the other seems to be in charge of throwing a bucket of water on the shower floor in between guests, handing out communal shower slippers and locking you in. Yes, the attendant locks you in, and there is no secondary lock on the inside for the vulnerable person who is naked and preoccupied. There are about 12 rooms and none that I’ve used have been particularly nice, each showing the black of mildew and/or mold. There’s no doubt it wasn’t always a shower-house, though, as the rooms are different configurations and the water comes via PVC pipes literally strung up to the rafters. It turns out, the temps at the shower-house are unpredictable and, for the most part, unadjustable. Regardless, that weekly shower is a treat. When you’re done, you give a knock and the attendant comes and unlocks your door.

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Oh, and by the way, it isn’t a lock with a key… just a simple slider. I want to think this is another example of trust built into things in Mongolia, but then I remembered, it’s like showering at a gym or a campground back home. Except for the whole gender-separation thing that is largely ignored here.