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December 2010

I would like to wish everyone a Happy Holiday Season and wonderful New Year!

Let me start with a most basic appeal:  Please Send Money! I know it seems a little forward, but if we don't ask, you won't send.  As you read about the wonderful work FIRE has accomplished this past year, but more importantly about the really substantial work we hope to complete in 2011, please bear in mind that FIRE needs your financial support in order to do so.

Much of our work is directed at helping to sustain a healthy population of medical professionals who can provide health care to the children of Mongolia and their mothers and fathers.  A doctor is paid an average of $300 per month.  A nurse is paid $200 per month.  The government just does not have the financial wherewithal to protect these valuable "natural resources".  That is where the efforts of FIRE have the potential to be so important.  If, through our efforts, we can help save the health and lives of highly trained medical professionals, then they will be able to provide medical care for thousands of patients in the years to come.  It is this multiplier effect that makes our efforts so powerful.  So please help us to continue putting good health directly in the hands of the people.
Now, to the good stuff:

2010 has been an amazing year.  Thanks to everyone who contributed to our successes!  We helped to deliver over 34,000
safety boxes, provided health safety training to over 500 health care professionals, began planning a patient safety i
initiative, completed the planning for both the Hepatitis study and the Knowledge, Attitudes and Practices survey, and began work on several other projects, all of which are described in further detail below.  We initiated voluntary fellowships for Mongolian medical graduate students, gaining four very talented individuals.  They benefit by working on topics for their theses, and we gain high quality in-country talent to support our projects. However, we lost our Medical Director, Dr. Naranygerel Erdenbelig, to NIH in Washington, on a two year paid fellowship.  But the good news is that Nara will be training for and then working on the Hepatitis study at NIH, discussed below.

Our total projected budget for 2011 is $450,000.  We have 5 projects that require funding via donations. Please help us to sustain the projects described below.  If one of the projects is of particular interest to you, we encourage you to specify that your donation go toward that project.  Big or small, every dollar helps.  But we need to receive your donation before the end of the year in order for you to take the tax deduction, and it will help us know what we can expect to accomplish next year.  Thank you in advance for your continued support (and prompt response!).

Love to all,

Meredith Potts,
Executive Director 
Hepatitis in Mongolia
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With the growing incidence of blood borne diseases, such as Hepatitis B and C among health care workers (HCWs) in Mongolia, medical waste management and health safety issues are of increasing concern among Mongolia's public health sector, as well as international health professionals. Multiple studies conducted in Mongolia from 1992 - 2007 have shown that over 50% of health care workers are co-infected with both Hepatitis B and C. Most developed countries have been successful in reducing HBV rates below 10% in HCWs through aggressive vaccination and safety & health education strategies.  The figures in Mongolia demand similar action.

Contaminated needles and other sharps exhibit the ability to create a portal of entry for infection through punctures and cuts.  In 2006, it was determined that needle stick injuries occurred among 39.4% of Mongolian health care workers (G. Soyolgerel, 2006) and increased up to 82.6% in a follow up study conducted in 2008 (G. Narantuya, 2008).   In preliminary studies conducted by FIRE, HCWs have indicated a high incidence of puncture injuries - sometimes as many as 40 times a month.  These injuries were observed to go unreported and most hospitals did not have a mechanism in place for the HCWs to report and treat their injury. The lack of proper management of medical waste, and the concomitant infection of and injury to HCWs and their patients, has gradually been acknowledged as a public health problem in Mongolia, but the country does not have resources adequate to wage a major campaign of awareness and prevention.  FIRE has, therefore, undertaken to assist in both areas until sufficient public health resources can be brought to bear.
Sharps Containers
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This program provides important training to health care workers, waste handlers and inspection agents about the proper use of "safety boxes" (sharps containers) and safe disposal of sharps waste nationwide.  The objective is to substantially reduce the number of inadvertent needle sticks and lacerations with contaminated needles or other medical sharps waste.  A number of Rotary Clubs in Mongolia and U.S. collaborate to purchase and ship the annual or biannual supply of approved safety boxes, made to WHO design specifications, to province health care facilities.  FIRE coordinates with the Clubs, the local Health Department and the Ministry of Health on the logistics for distribution, and then provides the training, as well as wall posters and other resource materials for each health care facility, designed and developed by FIRE.

19,100 boxes were distributed in May in Khenti Province. That was enough for a two-year supply for every hospital and health care clinic.  Please follow this link to view a slideshow of the Khenti distribution and FIRE's training of 100 health care workers from across the province.

On December 5, another 14,000 boxes were distributed in Sukhbatar Province with corresponding training for 100 health care workers representing all 23 health care facilities throughout the province. Please follow this link to watch a short video of FIRE's training seminar.

Next year, FIRE expects to provide safety box training in two additional provinces, at a cost of $6,000.

For more information, please visit our sharps containers page.
Health Safety Training Program
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In partnership with several national and international organizations focused on improving the health care system in Mongolia, FIRE is developing and expects to implement a comprehensive medical waste management training program inclusive of health & safety best practices, infection control and patient safety that will be disseminated nationwide throughout all three health care levels of Mongolia as well as the general public and policy makers.  

Inherent to the delivery of health care is the generation of potentially infectious wastes. If this waste is not handled and processed appropriately, it can represent an infection risk to health care workers, waste handlers, patients and general public.  With an appropriate medical waste management program inclusive of education on infection control as well as health and safety best practices, health care providers can protect themselves and their patients from hospital acquired HIV, Hepatitis B (HBV) and C (HCV) as well as other infections.

Starting in 2011 and continuing over the next 3 years, FIRE plans to directly train one quarter of Mongolia's health care workers at a cost of $1,000,000 contingent up receipt of sufficient funding.

For more information, please visit our medical waste management and health safety training program page.
Hepatitis Program
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FIRE has initiated an effort to study the prevalence of blood borne pathogens among urban, suburban and rural high risk health care workers in Mongolia.  Dr. Franco Marincola, TenGer Flyerured Senior Investigator at NIH, will scientifically study the relationship between Mongolians and Hepatitis B, C and D as well as HIV, HPV and HHV. He is providing the fellowship for our former medical director, Dr. Narnygerel Erdenebelig to train in his laboratory and to be an integral part of the study team in Washington. NIH's cutting edge information will provide heretofore unavailable information to the Mongolian public health sector for the treatment and prevention of these viruses, specifically Hepatitis.  The study's results will provide deep insight into transmittable infections (i.e, is there a genetic predisposition toward contracting Hepatitis, or against being able to clear it?).  Mongolian authorities will have a highly specific resource from which to form health policy and develop strategies for increasing awareness, prevention, detection and treatment of HCWs. 



Studies have shown that 93% of liver cancer in patients in Mongolia are also affected by hepatitis. Proving such a high incidence of infection and co-infection would increase the value of studying (in the future) prospectively affected individuals to discover important information regarding prevention and treatment of hepatocellular carcinoma (HCC).


The study has gained the professional expertise and support of leading hepatitis researchers from within NIH. FIRE is very lucky to have these world recognized experts, such as Harvey Alter (Member of the US National Academy of Sciences) and Stefano Bertuzzi, one of the top administrators in the Office of the Director at NIH and advisor to the US President, associated with the study.


FIRE's role to date has been to coordinate and facilitate communications between multiple Mongolian governmental authorities and agencies, and NIH, and to obtain the necessary government approvals for the study. Following receipt of sufficient funds to proceed, FIRE will commence gathering blood samples from 1000 HCW's throughout the country in 2011, at a cost of $13,500.

For more information, please visit our hepatitis program page.
KAP Survey
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The Knowledge, Attitudes and Practices (KAP) study aims to address the serious hospital originating infections, their transmission and the environmental and occupational safety challenges confronting the health care system in Mongolia. Hepatitis has long been a disease of concern in Mongolia, where it is considered endemic.

A 2008 evaluation by World Health Organization (WHO) and the Asian Development Bank (ADB) concluded that stewardship and dysfunctional service delivery continue to affect the quality of available health care, particularly to Mongolia's rural and urban poor.  This KAP survey will assess: 1) the environmental health safety in particular water supply and sanitation; 2) medical waste disposal practices; and 3) occupational safety of HCWs and infection control.

In 2011, FIRE plans to survey 1200 health care workers across Mongolia at a cost of $30,000.  

For more information, please visit our KAP survey page.
Patient Safety Program
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Patient safety is a global concern that impacts developing, transitional and developed countries alike.  Increasingly, nations around the world are realizing the issues surrounding patient safety and prioritizing resources accordingly. Very little data traditionally exists in this area due to the lack of understanding and awareness of patient safety issues, under-reporting, or other reasons such as fear of employer retribution.  

The goal of this project is to assess the current patient safety practices and needs in the health care sector across Mongolia. This information will be used to establish the effectiveness of current practices and level of current knowledge among health care personnel. It will be used to set curriculum priorities and create training materials. This assessment will create a baseline for measurement and improvement of patient safety practices and guidelines to international standards.

In 2011, FIRE plans to asses the current patient safety practices and issues through out Mongolia at a cost of $80,000. 

For more information, please visit our patient safety page.
The Dulaan Project
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While we are still accepting the hand made items, sadly we are no longer able to ship to Mongolia.
The knitted items used to ship in our large cargo containers of clothing and medical items. We have, however, stopped shipping these containers, and it has become too expensive for us to ship individual boxes of knitted items.
Because we now have a permanent office in Mongolia that can receive your knitted items, you could mail your boxes to Mongolia directly. From our Mongolian office, we will gladly distribute them to the most needy of people.
PO 44, Box 870                          
Ulaanbaatar - 14250                                                    
Phone: 11-321-810 (please include the phone number)

You are also welcome to mail your boxes to our Arizona office. Items sent to the Arizona office will be distributed in the United States.
PO Box 22187
Flagstaff, AZ 86002
I am sorry for these changes to the Dulaan Project but am sure you will understand. Thank you for continuing to support FIRE and its projects.
Thank You!!
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We are very grateful for the support and assistance of so many wonderful people who help keep our wheels in motion! We would especially like to thank Dr. Francesco Marincola and Ena Wang from the National Institutes of Health, Charlie Ofelt, Dr. Bira Yamjmaa, Dr. Ayra Bira, Dr. Nymadawaa, Dr. Scott Patlovich and Krista Patlovich for their tireless efforts with our Hepatitis and Medical Waste Management Programs. 

We would also like to thank Oyun Sanjaasuren, a Member of Parliament, and The Zorig Foundation, Marc Watkins, Dr. Bolormaa Purevdorj and Mongolian Public Health Professionals Association, Dr. Salik Govind from WHO, Dr. Gerelmaa Luvsandugar, Dr. Molor Radnaabazar, and Dr. Narnygerel Erdenebelig, Luke Eggleston and so many more for their support in a vast number of ways.

Finally, we would like to thank Tim Coursen for his wonderful videography of our work.

We are looking forward to all of our future accomplishments together.  Thank you so much!

Oh, and did we mention that we need your donations now?  It may seem like overkill, but with a total budget of $450,000 for next year, we need a lot of people to join with us in our effort.  We do the hard stuff (like spending 9 months a year in Mongolia).  You can do the easy stuff.  So please, take ten minutes, write us a check, lick a stamp and put your donation in the mail today! See the information for sending your donation under "Donate Now".
Issue: 3
In This Issue
Hepatitis in Mongolia
Sharps Boxes
Health Safety Program
Hepatitis Program
KAP Survey
Patient Safety Program
Dulaan Project
Join Our Mailing List
Volunteers Needed!
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We are always looking for volunteers!  Help FIRE
with office work, local events,  and so much more.  Join us on one of our trips to Mongolia.  Be a personal fundraiser and organize your own FIRE event wherever you are. Committing your time is an invaluable use of your efforts.  We could not do this without you. Consider becoming a volunteer and truly helping to make FIRE's efforts a success. Please visit our volunteer web page or contact us today to learn more!
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Donate NOW!

Did we forget to ask you for money?  Despite the high return to the people of Mongolia to be achieved through FIRE's ambitious projects, these are difficult fundraising times for us. We hope you will make a donation in support of our many medical efforts.

You can donate directly on-line here.
Checks may also be mailed to PO Box 22187  / Flagstaff, AZ / 86002.

For other ways to support FIRE, please visit our how you can help web page.

Thank you very much for your continued support!
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Become a Community Partner
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FIRE thrives because of our generous local supporters. For over eleven years the community of Flagstaff and the United States at large, has helped FIRE to collect, pack and ship over 70 tons of winter clothing, medical and school supplies. These strong community ties are the foundation of FIRE.

Community Sponsor - Make a monthly contribution to FIRE of $10, $20, $50, or more to directly support FIRE programs.  Most of our monthly expenses stay local to our community.   A monthly automatic withdrawal allows us to continue operations
and guarantees your money directly supports FIRE and our immediate community.   

You may also join our Community Partnership Program as a restaurant or retail store.Please visit our Community Partnership webpage or  Contact us today for more information!

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Flagstaff International Relief Effort   928-779-2288